Healthcare Provider Details

I. General information

NPI: 1730506585
Provider Name (Legal Business Name): CAROLINA KIDNEY AND VASCULAR, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 MCLAMB PL
GOLDSBORO NC
27534-1647
US

IV. Provider business mailing address

2809 MCLAMB PL
GOLDSBORO NC
27534-1647
US

V. Phone/Fax

Practice location:
  • Phone: 919-580-9840
  • Fax: 919-580-9838
Mailing address:
  • Phone: 919-580-9840
  • Fax: 919-580-9838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT BRADEN DUNMIRE III
Title or Position: PRESIDENT
Credential: MD
Phone: 919-580-9840