Provider Demographics
NPI:1841487006
Name:CAROLINA UROLOGICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:CAROLINA UROLOGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-245-2131
Mailing Address - Street 1:445 PINEVIEW DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3817
Mailing Address - Country:US
Mailing Address - Phone:336-993-8863
Mailing Address - Fax:
Practice Address - Street 1:445 PINEVIEW DR
Practice Address - Street 2:SUITE 230
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3817
Practice Address - Country:US
Practice Address - Phone:336-993-8863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012C5Medicaid
NCCH9569OtherRR MEDICARE
NC89012C5Medicaid