Individual
CARLOS JOSE ANCIANO GRANADILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
115 HEART DR, GREENVILLE, NC 27834-8982
(252) 744-4400
(252) 744-3987
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2013-01958
NC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
2013-01958
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154563906
—
NC
01
—
184R0
BCBS NC
NC
Enumeration date
03/25/2009
Last updated
01/24/2024
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