Healthcare Provider Details

I. General information

NPI: 1740716059
Provider Name (Legal Business Name): CAROLINA ORTHOPEDIC AND SPORTS MEDICINE, INC - KINSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DOCTORS DR SUITE N
KINSTON NC
28501-1589
US

IV. Provider business mailing address

701 DOCTORS DR SUITE N
KINSTON NC
28501-1589
US

V. Phone/Fax

Practice location:
  • Phone: 282-559-5662
  • Fax: 252-552-5662
Mailing address:
  • Phone: 282-559-5662
  • Fax: 252-552-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK GRAHAM WERTMAN
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 252-634-2676