Provider Demographics
NPI:1548529878
Name:CAROLINA FAMILY HEALTHCARE, PA
Entity type:Organization
Organization Name:CAROLINA FAMILY HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:P
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 STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0716
Mailing Address - Country:US
Mailing Address - Phone:704-847-4000
Mailing Address - Fax:704-847-4001
Practice Address - Street 1:11220 ELM LN STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-0716
Practice Address - Country:US
Practice Address - Phone:704-847-4000
Practice Address - Fax:704-847-4001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA FAMILY HEALTHCARE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-07
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty