Provider Demographics
NPI:1942287354
Name:PROCHNAU, CAROLINE C (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:C
Last Name:PROCHNAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4937
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4937
Mailing Address - Country:US
Mailing Address - Phone:336-633-3073
Mailing Address - Fax:336-633-3074
Practice Address - Street 1:306 N COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5528
Practice Address - Country:US
Practice Address - Phone:336-633-3073
Practice Address - Fax:336-633-3074
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128Y1Medicaid
NCH36526Medicare UPIN
NC89128Y1Medicaid