MEDICARE: CAROLINA PLASTIC SURGERY AND LASER CENTER, PA

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1659541464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA PLASTIC SURGERY AND LASER CENTER, PA

Provider Business Mailing Address
First Line	:	1721 EBENEZER RD STE 205
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1119
Country	:	US
Telephone Number	:	803-328-1919
Fax Number	:	803-328-1818

Provider Business Practice Location Address
First Line	:	1721 EBENEZER RD STE 205
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-1119
Country	:	US
Telephone Number	:	803-328-1919
Fax Number	:	803-328-1818

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTOPHER R CRAWFORD
Credential	:	M.D.
Telephone Number	:	803-328-1919

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	04/05/2012

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