Organization
CENTRAL CAROLINA NEPHROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM KENNETH HALSTENBERG MD (PRESIDENT)
(704) 786-7770
Entity
Organization
Contact information
Practice address
200 MEDICAL PARK DR, STE 320, CONCORD, NC 28025-2982
(704) 786-7770
(704) 788-9351
Mailing address
200 MEDICAL PARK DR, STE 320, CONCORD, NC 28025-2982
(704) 786-7770
(704) 788-9351
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0213H
BCBS GROUP #
NC
05
—
890213H
—
NC
Enumeration date
02/21/2006
Last updated
08/22/2020
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