Basic Information
| Provider Information | |||||||||
| NPI: | 1295728426 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAROMONT OCCUPATIONAL MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 COURT DRIVE | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048343070 | ||||||||
| FaxNumber: | 7048343073 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 COURT DRIVE | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280542140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048343070 | ||||||||
| FaxNumber: | 7048343073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2005 | ||||||||
| LastUpdateDate: | 07/23/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/17/2007 | ||||||||
| NPIReactivationDate: | 07/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | OWENSBY | ||||||||
| AuthorizedOfficialFirstName: | CHARLTON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7048343070 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 2083X0100X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.