Organization
CAROLINA VASCULAR SPECIALISTS, PA
Active
Organization
CAROLINA VASCULAR SPECIALISTS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALLACE C TARRY M.D. (OWNER/PROVIDER)
(704) 799-3939
Entity
Organization
Contact information
Practice address
146 MEDICAL PARK RD, SUITE 102, MOORESVILLE, NC 28117-8528
(704) 799-3939
(704) 799-8748
Mailing address
146 MEDICAL PARK RD, SUITE 102, MOORESVILLE, NC 28117-8528
(704) 799-3939
(704) 799-8748
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5917234
—
NC
Enumeration date
04/12/2011
Last updated
10/13/2011
Update your record
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