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General NPI Number Information
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NPI Number | 1477512812
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Entity Type | Organization
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Legal Business Name | CAROLINA ADULT MEDICINE, PA
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 568 RUIN CREEK RD SUITE 002
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City | HENDERSON
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State | NC
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Zip | 27536-2880
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Country | US
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Telephone | 252-438-7777
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Fax | 252-438-7190
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Provider Business Mailing Address
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Address Line | 568 RUIN CREEK RD SUITE 002
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City | HENDERSON
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State | NC
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Zip | 27536-2880
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Country | US
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Telephone | 252-438-7777
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Fax | 252-438-7190
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK JOHN GRUCHACZ
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Credential | M.D.
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Telephone | 252-438-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9700258
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 9701734
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License Number State | NC
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