Provider Demographics
NPI:1780621029
Name:CAROLINA MEDICINE, P.C.
Entity type:Organization
Organization Name:CAROLINA MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:WHITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:919-718-5705
Mailing Address - Street 1:310 COURT SQUARE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28330-5657
Mailing Address - Country:US
Mailing Address - Phone:919-718-5705
Mailing Address - Fax:919-777-7248
Practice Address - Street 1:310 COURT SQUARE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:28330-5657
Practice Address - Country:US
Practice Address - Phone:919-718-5705
Practice Address - Fax:919-777-7248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909263Medicaid
NC8913246Medicaid