Healthcare Provider Details

I. General information

NPI: 1073553509
Provider Name (Legal Business Name): CAROLINA REGIONAL ORTHOPAEDICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 N MAIN ST
TARBORO NC
27886-1921
US

IV. Provider business mailing address

2906 N MAIN ST
TARBORO NC
27886-1921
US

V. Phone/Fax

Practice location:
  • Phone: 252-823-7212
  • Fax: 252-823-5668
Mailing address:
  • Phone: 252-823-7212
  • Fax: 252-823-5668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON BRAKE
Title or Position: OFFICE SUPERVISOR
Credential:
Phone: 252-823-7212