Provider Demographics
NPI:1740463454
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:D
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:27804-6032
Mailing Address - Country:US
Mailing Address - Phone:252-937-4100
Mailing Address - Fax:252-937-4103
Practice Address - Street 1:215 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4913
Practice Address - Country:US
Practice Address - Phone:252-535-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAROLINA OTOLARYNGOLOGY CONSULTANTS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901256Medicaid
NC8901256Medicaid