Provider Demographics
NPI:1235316787
Name:JAMES D CROWTHER M.D. P.A.
Entity Type:Organization
Organization Name:JAMES D CROWTHER M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-872-5296
Mailing Address - Street 1:3410 EXECUTIVE DR
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7450
Mailing Address - Country:US
Mailing Address - Phone:919-872-5296
Mailing Address - Fax:919-850-9718
Practice Address - Street 1:3410 EXECUTIVE DR
Practice Address - Street 2:SUITE # 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7450
Practice Address - Country:US
Practice Address - Phone:919-872-5296
Practice Address - Fax:919-850-9718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73202207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00274036OtherRAILROAD MEDICARE
NC5598020001Medicare NSC
NC2348078Medicare PIN