Provider Demographics
NPI:1780628685
Name:CAROLINA EAR, NOSE & THROAT-SINUS AND ALLERGY CENTER PA
Entity Type:Organization
Organization Name:CAROLINA EAR, NOSE & THROAT-SINUS AND ALLERGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:BROOK
Authorized Official - Middle Name:
Authorized Official - Last Name:FULMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-2183
Mailing Address - Street 1:256 10TH AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3882
Mailing Address - Country:US
Mailing Address - Phone:828-322-2183
Mailing Address - Fax:828-322-7279
Practice Address - Street 1:1446 E GASTON ST STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4441
Practice Address - Country:US
Practice Address - Phone:704-748-6712
Practice Address - Fax:828-322-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Y00000X
NC207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0298QOtherBCBS
NC2344344Medicare ID - Type Unspecified