Organization
NORTH CAROLINA PHLEBOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN AMORUSO (SR VP REVENUE)
(847) 593-8460
Entity
Organization
Contact information
Practice address
326 S SHARON AMITY RD, CHARLOTTE, NC 28211-2806
(704) 442-2400
(704) 364-0713
Mailing address
PO BOX 1602, NORTHBROOK, IL 60065-1602
(847) 593-8460
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
—
NC
2085R0204X
Vascular & Interventional Radiology Physician
—
NC
208600000X
Surgery Physician
Primary
—
NC
2086S0129X
Vascular Surgery Physician
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE0112
MEDICARE RAILROAD
NC
Enumeration date
06/21/2006
Last updated
05/04/2023
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