Provider Demographics
NPI:1982621546
Name:ATLANTIC INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:ATLANTIC INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-754-8921
Mailing Address - Street 1:16 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-3350
Mailing Address - Country:US
Mailing Address - Phone:910-754-8921
Mailing Address - Fax:910-754-7140
Practice Address - Street 1:16 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-3350
Practice Address - Country:US
Practice Address - Phone:910-754-8921
Practice Address - Fax:910-754-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013FEOtherBCBS
NC79013FEMedicaid
NC79013FEMedicaid