Provider Demographics
NPI:1174535082
Name:CRAVEN, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CRAVEN
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 1:4761 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4359
Mailing Address - Country:US
Mailing Address - Phone:252-399-2112
Mailing Address - Fax:252-399-2138
Practice Address - Street 1:4761 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4359
Practice Address - Country:US
Practice Address - Phone:252-399-2112
Practice Address - Fax:252-399-2138
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC385972084N0400X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC25321OtherBLUE CROSS
NC8925321Medicaid
NCF25406Medicare UPIN
NC25321OtherBLUE CROSS