Provider Demographics
NPI:1013955574
Name:CARDIOLOGY ASSOCIATES OF JOHNSTON, PLLC
Entity type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF JOHNSTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-359-8040
Mailing Address - Street 1:PO BOX 16325
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6325
Mailing Address - Country:US
Mailing Address - Phone:919-967-6646
Mailing Address - Fax:919-967-6647
Practice Address - Street 1:11618 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2253
Practice Address - Country:US
Practice Address - Phone:919-359-8040
Practice Address - Fax:919-359-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900559Medicaid
2346098Medicare PIN