Provider Demographics
NPI:1215995444
Name:CAROLINA ASTHMA AND ALLERGY CENTER PA
Entity type:Organization
Organization Name:CAROLINA ASTHMA AND ALLERGY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-372-7900
Mailing Address - Street 1:PO BOX 63376
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3376
Mailing Address - Country:US
Mailing Address - Phone:704-372-7900
Mailing Address - Fax:704-376-2216
Practice Address - Street 1:2630 E 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4319
Practice Address - Country:US
Practice Address - Phone:704-372-7900
Practice Address - Fax:704-376-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-18118207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901284Medicaid
NC01284OtherBCBS
SCE01284Medicaid
NC7901284Medicaid
NC2325437Medicare PIN