Provider Demographics
NPI:1235194671
Name:CATHCART, CORNELIUS F (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:F
Last Name:CATHCART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 RUIN CREEK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2878
Mailing Address - Country:US
Mailing Address - Phone:252-492-9565
Mailing Address - Fax:252-492-5373
Practice Address - Street 1:451 RUIN CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2878
Practice Address - Country:US
Practice Address - Phone:252-492-9565
Practice Address - Fax:252-492-5373
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20884208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-21709Medicaid
NCC81366Medicare UPIN