Provider Demographics
NPI:1053519710
Name:CAROLINA INFECTIOUS DISEASE AND CRITICAL CARE ASSOCIATES, LLC
Entity type:Organization
Organization Name:CAROLINA INFECTIOUS DISEASE AND CRITICAL CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - SINGLE MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:ABHIJEET
Authorized Official - Middle Name:S
Authorized Official - Last Name:NADKARNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-974-3901
Mailing Address - Street 1:PO BOX 2467
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-2467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11137 MCCLURE MANOR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3027
Practice Address - Country:US
Practice Address - Phone:917-974-3901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-04
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29472207RC0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4711Medicaid
SCGP4711Medicaid