Provider Demographics
NPI:1043317043
Name:KOSKINAS, CARLA MANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MANN
Last Name:KOSKINAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2801 LYNDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4109
Mailing Address - Country:US
Mailing Address - Phone:336-768-9575
Mailing Address - Fax:949-862-8929
Practice Address - Street 1:730 HIGHLAND OAKS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-7108
Practice Address - Country:US
Practice Address - Phone:336-765-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102078363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2753740AMedicare ID - Type Unspecified
NCP44590Medicare UPIN