Basic Information
| Provider Information | |||||||||
| NPI: | 1952567166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOUGLASS | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | SHOSHANA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 712 FLEMING ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287913502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286947630 | ||||||||
| FaxNumber: | 8286947631 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 FLEMING ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286947630 | ||||||||
| FaxNumber: | 8286947631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 58.002480 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2011-01494 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | NC2698A | 01 | NC | MEDICARE PTAN | OTHER | 5918234 | 05 | NC | MEDICAID | P01019062 | 01 | NC | RR MEDICARE | OTHER |