Healthcare Provider Details

I. General information

NPI: 1447220827
Provider Name (Legal Business Name): CAROLYN S MENENDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MACON POND RD
RALEIGH NC
27607-6319
US

IV. Provider business mailing address

4101 MACON POND RD
RALEIGH NC
27607-6319
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-8200
  • Fax:
Mailing address:
  • Phone: 919-782-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number016523
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2008-00011
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: