1639388614 NPI number — DR. CHARLES CARLOS CROWELL III M.D.

Table of content: DR. CHARLES CARLOS CROWELL III M.D. (NPI 1639388614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639388614 NPI number — DR. CHARLES CARLOS CROWELL III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CROWELL
Provider First Name:
CHARLES
Provider Middle Name:
CARLOS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639388614
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 QUAKER LN
Provider Second Line Business Mailing Address:
STE D201
Provider Business Mailing Address City Name:
HIGH POINT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27262-3832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-884-3400
Provider Business Mailing Address Fax Number:
336-884-3401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 QUAKER LN
Provider Second Line Business Practice Location Address:
STE 207C
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27262-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-883-2500
Provider Business Practice Location Address Fax Number:
336-883-9728
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  17942 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 562158471 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1131 . This is a "PARTNERS MEDICARE CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 26133 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 562158471 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8926133 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90048 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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