Provider Demographics
NPI:1952567166
Name:DOUGLASS, CARA SHOSHANA (DO)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:SHOSHANA
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3502
Mailing Address - Country:US
Mailing Address - Phone:828-694-7630
Mailing Address - Fax:828-694-7631
Practice Address - Street 1:712 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791
Practice Address - Country:US
Practice Address - Phone:828-694-7630
Practice Address - Fax:828-694-7631
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.002480207R00000X
SC87933207R00000X
NC2011-01494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01019062OtherRR MEDICARE
NCNC2698AOtherMEDICARE PTAN
NC5918234Medicaid