Provider Demographics
NPI:1134371594
Name:CAROLINA VASCULAR WELLNESS, PLLC
Entity type:Organization
Organization Name:CAROLINA VASCULAR WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:MOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-226-3694
Mailing Address - Street 1:5318 HIGHGATE DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6630
Mailing Address - Country:US
Mailing Address - Phone:919-226-3694
Mailing Address - Fax:919-226-3699
Practice Address - Street 1:5318 HIGHGATE DR
Practice Address - Street 2:SUITE 135
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6630
Practice Address - Country:US
Practice Address - Phone:919-226-3694
Practice Address - Fax:919-226-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363L00000X, 207RI0200X, 207RG0300X, 208000000X, 208600000X, 207L00000X, 207RR0500X, 293D00000X, 247100000X, 163W00000X, 163WI0500X, 163WX0200X, 261QI0500X
NC2006-00963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No163WX0200XNursing Service ProvidersRegistered NurseOncologyGroup - Multi-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion TherapyGroup - Multi-Specialty