Provider Demographics
NPI:1376536151
Name:ROWE, KRISTINA D (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:D
Last Name:ROWE
Suffix:
Gender:F
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:PO BOX 896206
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6206
Mailing Address - Country:US
Mailing Address - Phone:252-447-7088
Mailing Address - Fax:252-447-2752
Practice Address - Street 1:532 WEBB BLVD.
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532
Practice Address - Country:US
Practice Address - Phone:252-447-7088
Practice Address - Fax:252-447-2758
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130F6OtherBLUE CROSS
NC89130F6Medicaid
NC2295196Medicare ID - Type Unspecified
E43795Medicare UPIN
NC89130F6Medicaid