Provider Demographics
NPI:1861425233
Name:CAROLINA SPORTS MEDICINE &ORTHOPAEDIC SPECIALISTS PA
Entity type:Organization
Organization Name:CAROLINA SPORTS MEDICINE &ORTHOPAEDIC SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESPOSITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-799-0110
Mailing Address - Street 1:1717 SHIPYARD BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8023
Mailing Address - Country:US
Mailing Address - Phone:910-799-0110
Mailing Address - Fax:910-799-1958
Practice Address - Street 1:1717 SHIPYARD BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8023
Practice Address - Country:US
Practice Address - Phone:910-799-0110
Practice Address - Fax:910-799-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890262NMedicaid
NC0262NOtherBCBS PROVIDER NUMBER
NC22064OtherCIGNA PROVIDER NUMBER
NC=========OtherUNITED HEALTHCARE
NC=========OtherTRICARE
NC22064OtherCIGNA PROVIDER NUMBER
NC0262NOtherBCBS PROVIDER NUMBER