Provider Demographics
NPI:1740716059
Name:CAROLINA ORTHOPEDIC AND SPORTS MEDICINE, INC - KINSTON
Entity type:Organization
Organization Name:CAROLINA ORTHOPEDIC AND SPORTS MEDICINE, INC - KINSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:WERTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-634-2676
Mailing Address - Street 1:701 DOCTORS DR
Mailing Address - Street 2:SUITE N
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1589
Mailing Address - Country:US
Mailing Address - Phone:282-559-5662
Mailing Address - Fax:252-552-5662
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:SUITE N
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1589
Practice Address - Country:US
Practice Address - Phone:282-559-5662
Practice Address - Fax:252-552-5662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA ORTHOPEDIC AND SPORTS MEDICINE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232097Medicare PIN