Provider Demographics
NPI:1306168497
Name:CAROLINA AESTHETIC AND RECONSTRUCTIVE SURGERY, PLLC
Entity type:Organization
Organization Name:CAROLINA AESTHETIC AND RECONSTRUCTIVE SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HONNEBIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-375-6766
Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-375-6766
Mailing Address - Fax:704-332-6552
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 550
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-375-6766
Practice Address - Fax:704-332-6552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200800118261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty