MEDICARE: CAROLINAS FERTILITY INSTITUTE

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	207VE0102X	Reproductive Endocrinology Physician

General Provider Information

NPI Number	:	1457986937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINAS FERTILITY INSTITUTE

Provider Business Mailing Address
First Line	:	PO BOX 25804
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27114-5804
Country	:	US
Telephone Number	:	336-448-9100
Fax Number	:	336-448-5282

Provider Business Practice Location Address
First Line	:	2614 E 7TH ST STE C
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-4397
Country	:	US
Telephone Number	:	980-256-2233
Fax Number	:	980-256-2234

Authorized Official
Title or Position	:	AR MANAGER
Name	:	PENNY RODRIGUEZ
Credential	:
Telephone Number	:	336-448-9100

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	03/05/2020

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