MEDICARE: CAROMONT MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437387750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROMONT MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	701 W TRADE ST
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-1544
Country	:	US
Telephone Number	:	704-922-3106
Fax Number	:	704-922-1369

Provider Business Practice Location Address
First Line	:	701 W TRADE ST
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-1544
Country	:	US
Telephone Number	:	704-922-3106
Fax Number	:	704-922-1369

Authorized Official
Title or Position	:	VP PRACTICE MANAGEMENT
Name	:	CRAIG A. DUNKER
Credential	:
Telephone Number	:	704-834-2135

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	07/27/2011

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Directions to “CAROMONT MEDICAL GROUP INC ” Practice Location

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