Provider Demographics
NPI:1962538751
Name:DOTY, CAROL SUE (PNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SUE
Last Name:DOTY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4347
Mailing Address - Country:US
Mailing Address - Phone:252-240-5437
Mailing Address - Fax:252-240-3084
Practice Address - Street 1:3604 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4347
Practice Address - Country:US
Practice Address - Phone:252-240-5437
Practice Address - Fax:252-240-3084
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300097208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine