MEDICARE: DR. CHARLES EDWARD CRAVEN JR. M.D.

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
1	207X00000X	Orthopaedic Surgery Physician	A71855	CA
2	207X00000X	Orthopaedic Surgery Physician	2019-01529	NC

General Provider Information

NPI Number	:	1508824491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EDWARD CRAVEN JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 VILLAGE MEDICAL CIR STE 110
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8029
Country	:	US
Telephone Number	:	336-893-2400
Fax Number	:	336-893-2410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	10/26/2020

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