Provider Demographics
NPI:1871563817
Name:CRABTREE, JR., THOMAS BENTLEY (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:BENTLEY
Last Name:CRABTREE, JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NC
Mailing Address - Zip Code:27915-0975
Mailing Address - Country:US
Mailing Address - Phone:252-995-3073
Mailing Address - Fax:252-995-6504
Practice Address - Street 1:40894 HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NC
Practice Address - Zip Code:27915
Practice Address - Country:US
Practice Address - Phone:252-995-3073
Practice Address - Fax:252-995-6504
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000-00390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127ANMedicaid
NC127ANOtherBCBS
2281049CMedicare ID - Type Unspecified
2281049DMedicare ID - Type Unspecified
NC89127ANMedicaid