Provider Demographics
NPI:1891796439
Name:CAROLINA MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:CAROLINA MEDICAL CLINIC PC
Other - Org Name:CAROLINA MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARANIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-782-6868
Mailing Address - Street 1:1000 COPPERFIELD BLVD NE
Mailing Address - Street 2:SUITE 124
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025
Mailing Address - Country:US
Mailing Address - Phone:704-782-6868
Mailing Address - Fax:704-782-7585
Practice Address - Street 1:1000 COPPERFIELD BLVD NE
Practice Address - Street 2:SUITE 124
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025
Practice Address - Country:US
Practice Address - Phone:704-782-6868
Practice Address - Fax:704-782-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4428770001Medicare NSC
NC2261775AMedicare PIN