Healthcare Provider Details

I. General information

NPI: 1831267681
Provider Name (Legal Business Name): CAROLINAS PLASTIC SURGERY CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 N NEW HOPE RD SUITE A
GASTONIA NC
28054-4037
US

IV. Provider business mailing address

760 N NEW HOPE RD SUITE A
GASTONIA NC
28054-4037
US

V. Phone/Fax

Practice location:
  • Phone: 704-866-8976
  • Fax: 704-866-8680
Mailing address:
  • Phone: 704-866-8976
  • Fax: 704-866-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9600039
License Number StateNC

VIII. Authorized Official

Name: DR. WALTER H CAULFIELD III
Title or Position: PRESIDENT
Credential: MD
Phone: 704-866-8976