Healthcare Provider Details

I. General information

NPI: 1700164464
Provider Name (Legal Business Name): CARTERET MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 MEDICAL PARK CT
MOREHEAD CITY NC
28557-4346
US

IV. Provider business mailing address

PO BOX 1648
MOREHEAD CITY NC
28557-1648
US

V. Phone/Fax

Practice location:
  • Phone: 252-247-2013
  • Fax: 252-247-7299
Mailing address:
  • Phone: 252-499-8610
  • Fax: 252-247-7299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANIE S KING
Title or Position: CFO
Credential:
Phone: 252-499-6104