Healthcare Provider Details

I. General information

NPI: 1861425233
Provider Name (Legal Business Name): CAROLINA SPORTS MEDICINE &ORTHOPAEDIC SPECIALISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SHIPYARD BLVD SUITE 350
WILMINGTON NC
28403-8023
US

IV. Provider business mailing address

1717 SHIPYARD BLVD SUITE 350
WILMINGTON NC
28403-8023
US

V. Phone/Fax

Practice location:
  • Phone: 910-799-0110
  • Fax: 910-799-1958
Mailing address:
  • Phone: 910-799-0110
  • Fax: 910-799-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A ESPOSITO
Title or Position: PRESIDENT
Credential: MD
Phone: 910-799-0110