Provider Demographics
NPI:1942285432
Name:CAROLINA FOOT SPECIALISTS PLLC
Entity Type:Organization
Organization Name:CAROLINA FOOT SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-846-1111
Mailing Address - Street 1:8305 FALLS OF NEUSE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3546
Mailing Address - Country:US
Mailing Address - Phone:919-846-1111
Mailing Address - Fax:919-846-1099
Practice Address - Street 1:8305 FALLS OF NEUSE RD
Practice Address - Street 2:STE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3546
Practice Address - Country:US
Practice Address - Phone:919-846-1111
Practice Address - Fax:919-846-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901521Medicaid
=========0007EOtherCIGNA-PRUDENTIAL
NC7901521Medicaid