Provider Demographics
NPI:1477508505
Name:CAROLINA VASCULAR SURGERY AND
Entity type:Organization
Organization Name:CAROLINA VASCULAR SURGERY AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:FOGARTIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:919-235-3400
Mailing Address - Street 1:3713 BENSON DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7372
Mailing Address - Country:US
Mailing Address - Phone:919-235-3400
Mailing Address - Fax:919-235-3401
Practice Address - Street 1:3713 BENSON DRIVE, SUITE 201
Practice Address - Street 2:CAROLINA VASCULAR SURGERY & DIAGNOSTICS, PA
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7372
Practice Address - Country:US
Practice Address - Phone:919-235-3400
Practice Address - Fax:919-235-3401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014EKMedicaid
DA1192OtherRAILROAD MEDIC
NCIP096OtherPARTNERS MEDICARE
NC464895OtherANTHEM
NC014EKOtherBLUE CROSS BLUE SHIELD
NCDA1192OtherMEDICARE RAILROAD
NC2331249Medicare PIN