Healthcare Provider Details

I. General information

NPI: 1164103578
Provider Name (Legal Business Name): CAROLINAS FERTILITY INSTITUTE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MACGREGOR PINES DR STE 206
CARY NC
27511-6037
US

IV. Provider business mailing address

PO BOX 25804
WINSTON SALEM NC
27114-5804
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-9100
  • Fax:
Mailing address:
  • Phone: 336-448-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: PENNY RODRIGUEZ
Title or Position: AR MANAGER
Credential:
Phone: 336-448-9100