Provider Demographics
NPI:1639388614
Name:CROWELL, CHARLES CARLOS III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CARLOS
Last Name:CROWELL
Suffix:III
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 1:624 QUAKER LN
Mailing Address - Street 2:STE D201
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-884-3400
Mailing Address - Fax:336-884-3401
Practice Address - Street 1:624 QUAKER LN
Practice Address - Street 2:STE 207C
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3832
Practice Address - Country:US
Practice Address - Phone:336-883-2500
Practice Address - Fax:336-883-9728
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17942207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562158471OtherCIGNA
NC1131OtherPARTNERS MEDICARE CHOICE
NC26133OtherBCBS
NC562158471OtherUNITED HEALTHCARE
NC8926133Medicaid
NC90048OtherMEDCOST
NC8926133Medicaid
NC26133OtherBCBS
NC562158471OtherCIGNA