Provider Demographics
NPI:1972834893
Name:CRAVEN NEUROLOGIC PA
Entity Type:Organization
Organization Name:CRAVEN NEUROLOGIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CRAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-399-7500
Mailing Address - Street 1:2402 CAMDEN ST SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-8608
Mailing Address - Country:US
Mailing Address - Phone:252-399-7500
Mailing Address - Fax:252-399-0123
Practice Address - Street 1:2402 CAMDEN ST SW
Practice Address - Street 2:SUITE 100
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-8608
Practice Address - Country:US
Practice Address - Phone:252-399-7500
Practice Address - Fax:252-399-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2169750DOtherMEDICARE ID - TYPE UNSPECIFIED
NC8925321Medicaid
NC25321OtherBLUE CROSS AND BLUE SHIELD OF NC
NC8925321Medicaid