=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790781698
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL D CRAWFORD M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2005
-----------------------------------------------------
Last Update Date | 10/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 SMITH CHURCH RD
-----------------------------------------------------
City | ROANOKE RAPIDS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27870-4913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-535-2311
-----------------------------------------------------
Fax | 252-937-4103
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 PERIMETER PARK DR SUITE 225
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-8421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 31262
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207YX0602X
-----------------------------------------------------
Taxonomy Name | Otolaryngic Allergy Physician
-----------------------------------------------------
License Number | 31262
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------