Healthcare Provider Details

I. General information

NPI: 1336348093
Provider Name (Legal Business Name): QING CAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 01/11/2022
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E FIRE TOWER RD ECU PHYSICIANS FAMILY MEDICINE FIRETOWER MEDICAL OFFICE
GREENVILLE NC
27858-4196
US

IV. Provider business mailing address

PO BOX 751069 ECU PHYSICIANS FAMILY MEDICINE
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-1122
  • Fax: 252-744-1133
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008-01627
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: