MEDICARE: CAROLINA NEUROSCIENCE INSTITUTE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	98-01269	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1163H	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275725558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA NEUROSCIENCE INSTITUTE, PC

Provider Business Mailing Address
First Line	:	4030 WAKE FOREST RD
Second Line	:	STE 115
City	:	RALEIGH
State	:	NC
Zip	:	27609-6800
Country	:	US
Telephone Number	:	919-239-0264
Fax Number	:	919-239-0266

Provider Business Practice Location Address
First Line	:	4030 WAKE FOREST RD
Second Line	:	STE 115
City	:	RALEIGH
State	:	NC
Zip	:	27609-6800
Country	:	US
Telephone Number	:	919-239-0264
Fax Number	:	919-239-0266

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. LORI RADCLIFFE
Credential	:
Telephone Number	:	919-239-0264

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	07/21/2008

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