Provider Demographics
NPI:1831267681
Name:CAROLINAS PLASTIC SURGERY CENTER PA
Entity type:Organization
Organization Name:CAROLINAS PLASTIC SURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:CAULFIELD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:704-866-8976
Mailing Address - Street 1:760 N NEW HOPE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4037
Mailing Address - Country:US
Mailing Address - Phone:704-866-8976
Mailing Address - Fax:704-866-8680
Practice Address - Street 1:760 N NEW HOPE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4037
Practice Address - Country:US
Practice Address - Phone:704-866-8976
Practice Address - Fax:704-866-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921748Medicaid
NC8921748Medicaid