Healthcare Provider Details

I. General information

NPI: 1831285840
Provider Name (Legal Business Name): CAROLINA INTERNAL MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 EMERALD PL
GREENVILLE NC
27834-5784
US

IV. Provider business mailing address

2460 EMERALD PL
GREENVILLE NC
27834-5784
US

V. Phone/Fax

Practice location:
  • Phone: 252-830-2021
  • Fax: 252-830-2042
Mailing address:
  • Phone: 252-830-2021
  • Fax: 252-830-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARK R CERVI
Title or Position: OWNER
Credential: M.D.
Phone: 252-830-2021