Provider Demographics
NPI:1942470182
Name:CARTERET INTERNAL MEDICINE AND CARDIOLGY CENTER, INC.
Entity Type:Organization
Organization Name:CARTERET INTERNAL MEDICINE AND CARDIOLGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDROTH
Authorized Official - Middle Name:VELANDY
Authorized Official - Last Name:PURUSHOTHAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-247-5426
Mailing Address - Street 1:212 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4305
Mailing Address - Country:US
Mailing Address - Phone:252-247-5426
Mailing Address - Fax:252-247-0287
Practice Address - Street 1:212 PENNY LN
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4305
Practice Address - Country:US
Practice Address - Phone:252-247-5426
Practice Address - Fax:252-247-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001544139174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0905Medicare PIN