Provider Demographics
NPI:1194742288
Name:CAROLINA SURGICAL ONCOLOGY, PC
Entity type:Organization
Organization Name:CAROLINA SURGICAL ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-580-8033
Mailing Address - Street 1:1 S COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-1807
Mailing Address - Country:US
Mailing Address - Phone:864-580-8033
Mailing Address - Fax:864-349-2145
Practice Address - Street 1:1058 BERMUDA RUN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0858
Practice Address - Country:US
Practice Address - Phone:864-580-8033
Practice Address - Fax:864-349-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27417174400000X
2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty