MEDICARE: CAROLINAS PHYSICIANS NETWORK, 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	2080P0202X	Pediatric Cardiology 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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952626376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINAS PHYSICIANS NETWORK, INC.

Provider Business Mailing Address
First Line	:	PO BOX 601067
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1067
Country	:	US
Telephone Number	:	704-373-1813
Fax Number	:	704-342-5871

Provider Business Practice Location Address
First Line	:	14214 BALLANTYNE LAKE ROAD
Second Line	:	SUITE 150
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3373
Country	:	US
Telephone Number	:	704-373-1813
Fax Number	:	704-342-5871

Authorized Official
Title or Position	:	SVP
Name	:	MR. THOMAS FORD LAYMON
Credential	:
Telephone Number	:	704-631-0002

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	08/17/2016

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