Provider Demographics
NPI:1851340434
Name:CAROLINA OTOLARYNGOLOGY CONSULTANTS, PA
Entity Type:Organization
Organization Name:CAROLINA OTOLARYNGOLOGY CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DILLON
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-937-4100
Mailing Address - Street 1:804 ENGLISH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-6023
Mailing Address - Country:US
Mailing Address - Phone:252-937-4100
Mailing Address - Fax:252-937-4103
Practice Address - Street 1:804 ENGLISH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-6023
Practice Address - Country:US
Practice Address - Phone:252-937-4100
Practice Address - Fax:252-937-4103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901256Medicaid
NC8901256Medicaid