Provider Demographics
NPI: | 1811008584 |
---|---|
Name: | CARL THOMAS DOVER JR |
Entity Type: | Organization |
Organization Name: | CARL THOMAS DOVER JR |
Other - Org Name: | MARTIN PEDIATRIC CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | SOLE PROPRIETOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CARL |
Authorized Official - Middle Name: | THOMAS |
Authorized Official - Last Name: | DOVER |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 252-792-8101 |
Mailing Address - Street 1: | 312 S MCCASKEY RD |
Mailing Address - Street 2: | PO BOX 845 |
Mailing Address - City: | WILLIAMSTON |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27892-2150 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-792-8101 |
Mailing Address - Fax: | 252-792-7287 |
Practice Address - Street 1: | 312 S MCCASKEY RD |
Practice Address - Street 2: | |
Practice Address - City: | WILLIAMSTON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27892-2150 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-792-8101 |
Practice Address - Fax: | 252-792-7287 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-31 |
Last Update Date: | 2008-07-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty |