Provider Demographics
NPI:1750337119
Name:CAROLINA BREAST CARE SPECIALISTS, PA
Entity type:Organization
Organization Name:CAROLINA BREAST CARE SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CANALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-741-5966
Mailing Address - Street 1:PO BOX 16814
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6814
Mailing Address - Country:US
Mailing Address - Phone:919-967-6646
Mailing Address - Fax:919-967-6647
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:SUITE 211
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-741-5966
Practice Address - Fax:919-571-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG23088Medicare UPIN