Provider Demographics
NPI:1154740561
Name:CAROLINA PARK MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:CAROLINA PARK MEDICAL CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:AJMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-774-5911
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-0400
Mailing Address - Country:US
Mailing Address - Phone:919-533-4804
Mailing Address - Fax:919-774-5957
Practice Address - Street 1:984 THOMPSON ST
Practice Address - Street 2:SUITE E2
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312
Practice Address - Country:US
Practice Address - Phone:919-533-4804
Practice Address - Fax:919-704-8552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC199625207N00000X, 207Q00000X, 207R00000X, 207RA0201X, 207RR0500X, 208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty