Provider Demographics
NPI:1255321360
Name:DOVER, CARON LEE BOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:CARON
Middle Name:LEE BOYD
Last Name:DOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARON
Other - Middle Name:BOYD
Other - Last Name:DOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1317 N. ELM STREET
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1023
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1317 N. ELM ST.
Practice Address - Street 2:SUITE 1B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1023
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99011212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC42116OtherPARTNERS
NCA8188OtherMEDCOST
NC1600168OtherUNITED HEALTHCARE
VA1255321360OtherVIRGINIA MEDICAID
NC300123092OtherRAILROAD MEDICARE
NC8912592Medicaid
NC12592OtherBLUE CROSS BLUE SHIELD
NC300123092OtherRAILROAD MEDICARE
NC2287441Medicare ID - Type Unspecified