Provider Demographics
NPI:1245226083
Name:DYKE, CORNELIUS MCKOWN (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:MCKOWN
Last Name:DYKE
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 1:801 BROADWAY N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-3641
Mailing Address - Country:US
Mailing Address - Phone:701-234-2331
Mailing Address - Fax:
Practice Address - Street 1:2555 COURT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2134
Practice Address - Country:US
Practice Address - Phone:704-671-7670
Practice Address - Fax:704-671-7672
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800242208G00000X
ND11686208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891127WMedicaid
SCN00243Medicaid
NCP00223121OtherRAILROAD MEDICARE
NDN716775Medicare PIN
NC891127WMedicaid
NCP00223121OtherRAILROAD MEDICARE
SCN00243Medicaid