Provider Demographics
NPI:1194987909
Name:CAROLINAS CENTER FOR DIGESTIVE HEALTH
Entity type:Organization
Organization Name:CAROLINAS CENTER FOR DIGESTIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUKAT
Authorized Official - Middle Name:
Authorized Official - Last Name:IFTIKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-266-0129
Mailing Address - Street 1:1603 MEDICAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5541
Mailing Address - Country:US
Mailing Address - Phone:910-266-0129
Mailing Address - Fax:910-266-8089
Practice Address - Street 1:1603 MEDICAL DR STE C
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5541
Practice Address - Country:US
Practice Address - Phone:910-266-0129
Practice Address - Fax:910-266-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000468207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPB274Medicaid
NC2025430CMedicare PIN