Provider Demographics
NPI:1700020310
Name:CAROLINA DIABETES AND ENDOCRINOLOGY CENTER
Entity Type:Organization
Organization Name:CAROLINA DIABETES AND ENDOCRINOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEDE
Authorized Official - Middle Name:I
Authorized Official - Last Name:NNOLIM
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:910-292-2066
Mailing Address - Street 1:520 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4518
Mailing Address - Country:US
Mailing Address - Phone:910-292-2066
Mailing Address - Fax:910-292-2091
Practice Address - Street 1:520 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4518
Practice Address - Country:US
Practice Address - Phone:910-292-2061
Practice Address - Fax:910-292-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00235207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty