Provider Demographics
NPI:1699737726
Name:CAROLINA NEUROSURGERY, PA
Entity type:Organization
Organization Name:CAROLINA NEUROSURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:O
Authorized Official - Last Name:KRITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-378-1040
Mailing Address - Street 1:301 E WENDOVER AVE
Mailing Address - Street 2:#211
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1230
Mailing Address - Country:US
Mailing Address - Phone:336-378-1040
Mailing Address - Fax:336-378-0250
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:#211
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-378-1040
Practice Address - Fax:336-378-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890248FMedicaid
NC890248FMedicaid