Healthcare Provider Details

I. General information

NPI: 1023296647
Provider Name (Legal Business Name): CAROLINA COLORECTAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 ATRIUM DR SUITE 305
RALEIGH NC
27607-6452
US

IV. Provider business mailing address

2501 ATRIUM DR SUITE 305
RALEIGH NC
27607-6452
US

V. Phone/Fax

Practice location:
  • Phone: 919-235-0216
  • Fax: 919-235-0217
Mailing address:
  • Phone: 919-235-0216
  • Fax: 919-235-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number200701309
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200701309
License Number StateNC

VIII. Authorized Official

Name: DR. SANKAR NAIDU ADUSUMILLI
Title or Position: CHAIRMAN
Credential: MD
Phone: 919-235-0216