Healthcare Provider Details

I. General information

NPI: 1003108317
Provider Name (Legal Business Name): CAROLINE L DENWOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 HOSPITAL DR
CLYDE NC
28721-8026
US

IV. Provider business mailing address

486 HOSPITAL DR
CLYDE NC
28721-8026
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-5816
  • Fax: 828-452-0373
Mailing address:
  • Phone: 828-452-5816
  • Fax: 828-452-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2015-00460
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: