Provider Demographics
NPI:1821197906
Name:MCCRORY, DOUGLAS CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:MCCRORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:508 FULTON ST
Mailing Address - Street 2:ACS (11-C)
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3875
Mailing Address - Country:US
Mailing Address - Phone:919-286-6963
Mailing Address - Fax:919-416-5881
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:ACS (11-C)
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-6963
Practice Address - Fax:919-416-5881
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC37895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8955885Medicaid
NC8955885Medicaid