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General NPI Number Information
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NPI Number | 1245296490
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Entity Type | Organization
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Legal Business Name | CAROLINA SURGERY PA
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1089 X RAY DR
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City | GASTONIA
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State | NC
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Zip | 28054-7489
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Country | US
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Telephone | 704-864-8377
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Fax | 704-864-4442
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Provider Business Mailing Address
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Address Line | 1089 X RAY DR
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City | GASTONIA
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State | NC
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Zip | 28054-7489
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Country | US
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Telephone | 704-864-8377
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Fax | 704-864-4442
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW IRA LIGHT
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Credential | MD
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Telephone | 704-864-8377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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