Provider Demographics
NPI:1013925486
Name:JORGE, CARLOS B (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:B
Last Name:JORGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:309 S SHARON AMITY RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2886
Mailing Address - Country:US
Mailing Address - Phone:704-360-5018
Mailing Address - Fax:980-273-1102
Practice Address - Street 1:309 S SHARON AMITY RD STE 206
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2886
Practice Address - Country:US
Practice Address - Phone:704-360-5018
Practice Address - Fax:980-273-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200201267207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132UPMedicaid
NC2009131Medicare ID - Type Unspecified
NC89132UPMedicaid
NC2009131EMedicare PIN