Basic Information
| Provider Information | |||||||||
| NPI: | 1851345920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE GRAW | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | CRAWFORD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12248 | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285612248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331678 | ||||||||
| FaxNumber: | 2526331403 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 MEDICAL PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285625248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526331678 | ||||||||
| FaxNumber: | 2526331403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2006 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 28166 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 27986 | 01 | NC | BCBS OF NC | OTHER | 8927986 | 05 | NC | MEDICAID |