Provider Demographics
NPI:1063667020
Name:CAROLINA GASTROENTEROLOGY SPECIALISTS PLLC
Entity type:Organization
Organization Name:CAROLINA GASTROENTEROLOGY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VENKATESH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-206-5622
Mailing Address - Street 1:3520 AIRPORT BLVD NW STE F
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8674
Mailing Address - Country:US
Mailing Address - Phone:252-206-5622
Mailing Address - Fax:252-206-5623
Practice Address - Street 1:3520 AIRPORT BLVD NW STE F
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8674
Practice Address - Country:US
Practice Address - Phone:252-206-5622
Practice Address - Fax:252-206-5623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA GASTROENTEROLOGY SPECIALISTS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-18
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAS0112261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409975Medicaid
NC3409975Medicaid