Healthcare Provider Details

I. General information

NPI: 1750337119
Provider Name (Legal Business Name): CAROLINA BREAST CARE SPECIALISTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL SUITE 211
RALEIGH NC
27607-7513
US

IV. Provider business mailing address

PO BOX 16814
CHAPEL HILL NC
27516-6814
US

V. Phone/Fax

Practice location:
  • Phone: 919-741-5966
  • Fax: 919-571-4330
Mailing address:
  • Phone: 919-967-6646
  • Fax: 919-967-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. SEAN THOMAS CANALE
Title or Position: PRESIDENT
Credential: MD
Phone: 919-741-5966