Healthcare Provider Details

I. General information

NPI: 1730127994
Provider Name (Legal Business Name): CRAIG J MCCOTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CRAIG JENNINGS MCCOTTER MD

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

IV. Provider business mailing address

1202 MEDICAL CENTER DR
WILMINGTON NC
28401-7307
US

V. Phone/Fax

Practice location:
  • Phone: 910-341-3421
  • Fax:
Mailing address:
  • Phone: 910-341-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2021-00544
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number21963
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number21963
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number50708
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: