Provider Demographics
NPI:1205882370
Name:COPENHAVER, CAROL ANNE BORACK (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL ANNE
Middle Name:BORACK
Last Name:COPENHAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:BORACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 N JUSTICE ST
Mailing Address - Street 2:BOX 16
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791
Mailing Address - Country:US
Mailing Address - Phone:828-694-8385
Mailing Address - Fax:
Practice Address - Street 1:156 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-5508
Practice Address - Country:US
Practice Address - Phone:828-891-0060
Practice Address - Fax:828-891-1425
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1646946OtherHIGHMARK PA BLUE SHIELD
NCNNP232N787OtherMEDICARE PTAN
PAP00322251OtherPALMETTO RR
NCP01169433OtherRR MEDICARE
NC2075753Medicare PIN
NCP01169433OtherRR MEDICARE