Healthcare Provider Details

I. General information

NPI: 1235700386
Provider Name (Legal Business Name): AUSTIN CHAPMAN-LOVETTE CROMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5175 OLD CLEMMONS SCHOOL RD
CLEMMONS NC
27012-9087
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-3960
  • Fax: 336-766-3691
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11390
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0010-11390
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: