Provider Demographics
NPI:1902251978
Name:CAROLINA FAMILY HEALTHCARE, PA
Entity Type:Organization
Organization Name:CAROLINA FAMILY HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINO
Authorized Official - Middle Name:
Authorized Official - Last Name:KANELOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-847-4000
Mailing Address - Street 1:11220 ELM LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0715
Mailing Address - Country:US
Mailing Address - Phone:704-847-4000
Mailing Address - Fax:704-847-4001
Practice Address - Street 1:11220 ELM LN
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0715
Practice Address - Country:US
Practice Address - Phone:704-847-4000
Practice Address - Fax:704-847-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC037353336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy