Provider Demographics
NPI:1689894321
Name:CAROLINA BONE & JOINT PA
Entity type:Organization
Organization Name:CAROLINA BONE & JOINT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOLDBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-274-6718
Mailing Address - Street 1:10508 PARK RD STE 120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8526
Mailing Address - Country:US
Mailing Address - Phone:704-541-3055
Mailing Address - Fax:704-319-2166
Practice Address - Street 1:1331 N ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6303
Practice Address - Country:US
Practice Address - Phone:336-274-6718
Practice Address - Fax:336-274-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC561316335207X00000X
NC335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902849Medicaid
NC8902849Medicaid
NC230769Medicare PIN