Provider Demographics
NPI:1538336979
Name:CAROLINA DIAB ENDOCR CLINI
Entity type:Organization
Organization Name:CAROLINA DIAB ENDOCR CLINI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-225-0400
Mailing Address - Street 1:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28111-0947
Mailing Address - Country:US
Mailing Address - Phone:704-225-0400
Mailing Address - Fax:704-296-2743
Practice Address - Street 1:710 DEWITT DR
Practice Address - Street 2:
Practice Address - City:LUGOFF
Practice Address - State:SC
Practice Address - Zip Code:29078-9069
Practice Address - Country:US
Practice Address - Phone:803-233-1730
Practice Address - Fax:803-233-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22076207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8335Medicare PIN