Provider Demographics
NPI:1013248905
Name:CAROLINA NEUROLOGY EAST
Entity type:Organization
Organization Name:CAROLINA NEUROLOGY EAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRISHWANT
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-924-7575
Mailing Address - Street 1:750 HARTNESS RD STE E
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3400
Mailing Address - Country:US
Mailing Address - Phone:704-924-7575
Mailing Address - Fax:704-924-7877
Practice Address - Street 1:223 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2038
Practice Address - Country:US
Practice Address - Phone:704-924-7575
Practice Address - Fax:704-924-7877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127CKMedicaid