Provider Demographics
NPI:1013936707
Name:DOVER, CARL T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:T
Last Name:DOVER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-0845
Mailing Address - Country:US
Mailing Address - Phone:252-792-4410
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:252-792-4410
Practice Address - Fax:252-792-7287
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC22907208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929128Medicaid
NC29128OtherBLUE CROSS/BLUE SHIELD
NCF42957Medicare UPIN