MEDICARE: CAROLINA CARDIOLOGY, SLEEP & OBESITY CENTER 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	207RB0002X	Obesity Medicine (Internal Medicine) Physician
2	207RC0000X	Cardiovascular Disease Physician	00-35439	NC
3	207RC0000X	Cardiovascular Disease Physician
4	207RS0012X	Sleep Medicine (Internal Medicine) Physician	00-35439	NC
5	207RS0012X	Sleep Medicine (Internal Medicine) Physician
6	207UN0901X	Nuclear Cardiology Physician	00-35439	NC
7	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1518397587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CARDIOLOGY, SLEEP & OBESITY CENTER PC

Provider Business Mailing Address
First Line	:	3280 HENDERSON DR STE C
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5290
Country	:	US
Telephone Number	:	910-915-8450
Fax Number	:	888-745-7026

Provider Business Practice Location Address
First Line	:	3280 HENDERSON DR STE C
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5290
Country	:	US
Telephone Number	:	910-915-8450
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHYAMAL KISHORE MITRA
Credential	:	M.D.
Telephone Number	:	252-525-3290

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	09/12/2022

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