Provider Demographics
NPI:1912912494
Name:CAROLINA UROLOGY CLINIC PA
Entity type:Organization
Organization Name:CAROLINA UROLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:910-642-5832
Mailing Address - Street 1:720 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3706
Mailing Address - Country:US
Mailing Address - Phone:910-642-5832
Mailing Address - Fax:910-642-8814
Practice Address - Street 1:720 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3706
Practice Address - Country:US
Practice Address - Phone:910-642-5832
Practice Address - Fax:910-642-8814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01601OtherBLUE CROSS
NCCG7448OtherRAIL ROAD MEDICARE
SCNPA160Medicaid
NC8901601Medicaid
SCNPA160Medicaid
NC=========OtherCIGNA
NCCG7448OtherRAIL ROAD MEDICARE
NC=========OtherTRICARE