Provider Demographics
NPI:1710026695
Name:CROWN CLINIC PA
Entity Type:Organization
Organization Name:CROWN CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:CHIKA
Authorized Official - Last Name:ORIAKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-527-5522
Mailing Address - Street 1:801 CLANTON RD
Mailing Address - Street 2:STE C110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-1372
Mailing Address - Country:US
Mailing Address - Phone:704-527-5522
Mailing Address - Fax:704-527-5533
Practice Address - Street 1:801 CLANTON RD STE C110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1372
Practice Address - Country:US
Practice Address - Phone:704-527-5522
Practice Address - Fax:704-527-5533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty