Provider Demographics
NPI:1154549673
Name:CARRAWAY, ANTHONY GLENN (M D)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GLENN
Last Name:CARRAWAY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 ANDERSON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1503
Mailing Address - Country:US
Mailing Address - Phone:919-783-6975
Mailing Address - Fax:919-783-6975
Practice Address - Street 1:2703 ANDERSON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-1503
Practice Address - Country:US
Practice Address - Phone:919-783-6975
Practice Address - Fax:919-783-6975
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC294642084H0002X, 2084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
Not Answered2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCEO1443Medicare UPIN