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General NPI Number Information
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NPI Number | 1619933637
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Entity Type | Organization
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Legal Business Name | CARLO P. YUSON MD PA
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 1900 S HAWTHORNE RD SUITE 358
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-3913
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Country | US
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Telephone | 336-768-5131
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 S.HAWTHORNE ROAD SUITE 358
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City | WINSTON-SALEM
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State | NC
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Zip | 27103
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Country | US
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Telephone | 336-768-5131
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLO PILAPIL YUSON
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Credential | M.D.
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Telephone | 336-768-5131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 20641
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License Number State | NC
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