Healthcare Provider Details

I. General information

NPI: 1154740561
Provider Name (Legal Business Name): CAROLINA PARK MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 THOMPSON ST SUITE E2
PITTSBORO NC
27312
US

IV. Provider business mailing address

PO BOX 400
SANFORD NC
27331-0400
US

V. Phone/Fax

Practice location:
  • Phone: 919-533-4804
  • Fax: 919-704-8552
Mailing address:
  • Phone: 919-533-4804
  • Fax: 919-774-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number199625
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number199625
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number199625
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number199625
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number199625
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number199625
License Number StateNC
# 7
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number199625
License Number StateNC

VIII. Authorized Official

Name: DR. AJAY K AJMANI
Title or Position: PRESIDENT
Credential: MD
Phone: 919-774-5911