Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 38752 | NC |
NPI | 1184835753 |
---|---|
Provider Name | Dr. Mary Thelma Crowder |
First Address | Charlotte, NC 28211-2974 |
Second Address | Charlotte, NC 28211-2974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 02/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BC2249591 | DEA (01) |