Healthcare Provider Details

I. General information

NPI: 1962733170
Provider Name (Legal Business Name): CAROLINA DERMATOLOGY AND ENDOCRINOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 MEDSPRING DR
CLAYTON NC
27520-9293
US

IV. Provider business mailing address

244 MEDSPRING DR
CLAYTON NC
27520-9293
US

V. Phone/Fax

Practice location:
  • Phone: 919-359-0291
  • Fax: 919-553-2907
Mailing address:
  • Phone: 919-359-0291
  • Fax: 919-553-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2008-01357
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2008-01358
License Number StateNC

VIII. Authorized Official

Name: SANJAY TOMAR
Title or Position: OWNER
Credential: MD
Phone: 919-359-0291