MEDICARE: CAROLINA PLASTIC SURGERY SPECIALISTS INC

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	2086S0122X	Plastic and Reconstructive Surgery Physician		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538124094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA PLASTIC SURGERY SPECIALISTS INC

Provider Business Mailing Address
First Line	:	504 E ELIZABETH ST
Second Line	:	STE 4
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4472
Country	:	US
Telephone Number	:	252-384-0919
Fax Number	:	252-384-0916

Provider Business Practice Location Address
First Line	:	504 E ELIZABETH ST
Second Line	:	STE 4
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4472
Country	:	US
Telephone Number	:	252-384-0919
Fax Number	:	252-384-0916

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN LOVELLE-ALLEN
Credential	:	MD
Telephone Number	:	252-384-0919

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	08/22/2020

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