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General NPI Number Information
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NPI Number | 1245226083
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Entity Type | Individual
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Provider Name | CORNELIUS MCKOWN DYKE MD
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 2555 COURT DR SUITE 200
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City | GASTONIA
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State | NC
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Zip | 28054-2134
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Country | US
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Telephone | 704-671-7670
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Fax | 704-671-7672
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Provider Business Mailing Address
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Address Line | 801 BROADWAY N
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City | FARGO
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State | ND
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Zip | 58102-3641
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Country | US
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Telephone | 701-234-2331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 9800242
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 11686
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License Number State | ND
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