Healthcare Provider Details

I. General information

NPI: 1548529878
Provider Name (Legal Business Name): CAROLINA FAMILY HEALTHCARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 ELM LN STE 102
CHARLOTTE NC
28277-0716
US

IV. Provider business mailing address

11220 ELM LN STE 102
CHARLOTTE NC
28277-0716
US

V. Phone/Fax

Practice location:
  • Phone: 704-847-4000
  • Fax: 704-847-4001
Mailing address:
  • Phone: 704-847-4000
  • Fax: 704-847-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DINO P KANELOS
Title or Position: OWNER
Credential: MD
Phone: 704-847-4000