Provider Demographics
NPI:1831114875
Name:CRUMLEY, CHARLES E (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:CRUMLEY
Suffix:
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 1:751 S LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3622
Mailing Address - Country:US
Mailing Address - Phone:704-735-3081
Mailing Address - Fax:704-735-1083
Practice Address - Street 1:751 S LAUREL ST
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3622
Practice Address - Country:US
Practice Address - Phone:704-735-3081
Practice Address - Fax:704-735-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891133YMedicaid
NC201588FMedicare PIN
NC201588EMedicare PIN
NC891133YMedicaid