Basic Information
| Provider Information | |||||||||
| NPI: | 1154384568 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROLINA NEUROSURGERY & SPINE ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 BALDWIN AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282043109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043761605 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 BALDWIN AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282043109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043761605 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 10/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | DYER | ||||||||
| AuthorizedOfficialFirstName: | EMMET | ||||||||
| AuthorizedOfficialMiddleName: | HUNTER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7043761605 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | CD7457 | 01 | RAILROAD MEDICARE | OTHER |