Provider Demographics
NPI:1831155738
Name:CHARLOTTE COLON & RECTAL SURGERY ASSOCIATES PA
Entity type:Organization
Organization Name:CHARLOTTE COLON & RECTAL SURGERY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-333-1259
Mailing Address - Street 1:2015 RANDOLPH RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1200
Mailing Address - Country:US
Mailing Address - Phone:704-333-1259
Mailing Address - Fax:704-333-0371
Practice Address - Street 1:2015 RANDOLPH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1200
Practice Address - Country:US
Practice Address - Phone:704-333-1259
Practice Address - Fax:704-333-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40475208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901403Medicaid
NC0787Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER