Provider Demographics
NPI:1962733170
Name:CAROLINA DERMATOLOGY AND ENDOCRINOLOGY, PA
Entity type:Organization
Organization Name:CAROLINA DERMATOLOGY AND ENDOCRINOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-359-0291
Mailing Address - Street 1:244 MEDSPRING DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-9293
Mailing Address - Country:US
Mailing Address - Phone:919-359-0291
Mailing Address - Fax:919-553-2907
Practice Address - Street 1:244 MEDSPRING DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9293
Practice Address - Country:US
Practice Address - Phone:919-359-0291
Practice Address - Fax:919-553-2907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01357207N00000X
NC2008-01358207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty