Provider Demographics
NPI:1780634907
Name:CAROLINA MOUNTAIN GASTROENTEROLOGY PA
Entity Type:Organization
Organization Name:CAROLINA MOUNTAIN GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:STAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-696-3099
Mailing Address - Street 1:1032 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3532
Mailing Address - Country:US
Mailing Address - Phone:828-696-3099
Mailing Address - Fax:828-696-3868
Practice Address - Street 1:1032 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3532
Practice Address - Country:US
Practice Address - Phone:828-696-3099
Practice Address - Fax:828-696-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427007855Medicare UPIN
NC1699945550Medicare UPIN
10553360982Medicare UPIN
NC1386693299Medicare UPIN