Provider Demographics
NPI:1962523050
Name:CAROLINA GASTROENTEROLOGY SPECIALISTS PLLC
Entity type:Organization
Organization Name:CAROLINA GASTROENTEROLOGY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATESH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-206-5622
Mailing Address - Street 1:3520 AIRPORT BLVD NW
Mailing Address - Street 2:SUITE F
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8674
Mailing Address - Country:US
Mailing Address - Phone:252-206-5622
Mailing Address - Fax:252-206-5623
Practice Address - Street 1:3520 AIRPORT BLVD NW STE F
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8674
Practice Address - Country:US
Practice Address - Phone:252-206-5622
Practice Address - Fax:252-206-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900445Medicaid
NC193133OtherMEDCOST
NC7407289OtherAETNA
NC1388COtherBCBS
NC193133OtherMEDCOST
NC193133OtherMEDCOST
NCH48431Medicare UPIN