Provider Demographics
NPI:1336230416
Name:CLOSSON, CAREY-WALTER FRANKLIN (MD)
Entity type:Individual
Prefix:DR
First Name:CAREY-WALTER
Middle Name:FRANKLIN
Last Name:CLOSSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:145 KIMEL PARK DR STE 330
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6972
Mailing Address - Country:US
Mailing Address - Phone:336-765-6181
Mailing Address - Fax:336-760-2149
Practice Address - Street 1:330 BILLINGSLEY RD STE 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5055
Practice Address - Country:US
Practice Address - Phone:336-765-6181
Practice Address - Fax:336-760-2149
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059643208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD336423200Medicaid
MD336423200Medicaid
DC249056ZB0UMedicare PIN
MD402058800Medicaid
MDH86866Medicare UPIN
MDG479Medicare PIN