Provider Demographics
NPI:1710996202
Name:MOORE, CRAIG COWAN (MD IM)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:COWAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:MD IM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 HART RD
Mailing Address - Street 2:
Mailing Address - City:PISGAH FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:28768-8637
Mailing Address - Country:US
Mailing Address - Phone:828-883-4757
Mailing Address - Fax:
Practice Address - Street 1:90 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712
Practice Address - Country:US
Practice Address - Phone:828-884-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8960522Medicaid
NC60522OtherBCBSNC ER PROF SERVICE
NC2182621FMedicare ID - Type UnspecifiedCIGNA MCR ER PROF SERVICE
NC8960522Medicaid