Healthcare Provider Details

I. General information

NPI: 1265463814
Provider Name (Legal Business Name): CAROLINA DIAGNOSTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 PHYSICIANS DR SUITE 102A
WILMINGTON NC
28401-7363
US

IV. Provider business mailing address

200 CORPORATE PL SUITE 5B
PEABODY MA
01960-3840
US

V. Phone/Fax

Practice location:
  • Phone: 910-772-1518
  • Fax: 910-772-1703
Mailing address:
  • Phone: 978-536-7400
  • Fax: 978-535-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CARL R IBERGER
Title or Position: EVP CFO
Credential:
Phone: 978-536-7400