Provider Demographics
NPI:1912953894
Name:CAROLINA EAST CARDIOLOGY, P.C.
Entity Type:Organization
Organization Name:CAROLINA EAST CARDIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-551-3444
Mailing Address - Street 1:1041 NOELL LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2058
Mailing Address - Country:US
Mailing Address - Phone:252-551-3444
Mailing Address - Fax:252-551-5588
Practice Address - Street 1:1041 NOELL LN
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2058
Practice Address - Country:US
Practice Address - Phone:252-551-3444
Practice Address - Fax:252-551-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2322898Medicare PIN