Provider Demographics
NPI:1427718618
Name:CAROLINA MEDICAL WAVE
Entity type:Organization
Organization Name:CAROLINA MEDICAL WAVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAMAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELSAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:336-749-9354
Mailing Address - Street 1:8415 GROVE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-3004
Mailing Address - Country:US
Mailing Address - Phone:336-749-9354
Mailing Address - Fax:
Practice Address - Street 1:1310 SE MAYNARD RD # 204-B
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3615
Practice Address - Country:US
Practice Address - Phone:336-749-9354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAADRA ENTERPRISE PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-29
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service