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NPI Code Detail

MEDICARE: CANTERWOOD MEDICAL GROUP

MEDICARE: CANTERWOOD MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1508007121
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANTERWOOD MEDICAL GROUP
Provider Business Mailing Address
First Line : PO BOX 71
Second Line :
City : WILMINGTON
State : NC
Zip : 28402-0071
Country : US
Telephone Number : 910-612-3252
Fax Number : 910-254-4888
Provider Business Practice Location Address
First Line : 2207 CANTERWOOD DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-7301
Country : US
Telephone Number : 910-254-4777
Fax Number : 910-254-4888
Authorized Official
Title or Position : OWNER
Name : CHRISTINE BATES
Credential :
Telephone Number : 99106123252
Provider Enumeration Date : 03/11/2009
Last Update Date : 05/25/2010

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Directions to “CANTERWOOD MEDICAL GROUP ” Practice Location

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