Healthcare Provider Details

I. General information

NPI: 1285643619
Provider Name (Legal Business Name): CAROLINAS PHYSICIANS NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 MALLARD CREEK RD SUITE 260
CHARLOTTE NC
28262-9756
US

IV. Provider business mailing address

PO BOX 60469
CHARLOTTE NC
28260-0469
US

V. Phone/Fax

Practice location:
  • Phone: 704-549-1992
  • Fax: 704-549-1322
Mailing address:
  • Phone: 704-549-1992
  • Fax: 704-549-1322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL L WEINS
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 704-355-0648