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NPI Code Detail

MEDICARE: DAN ECCLESTONE PA-C

MEDICARE: DAN ECCLESTONE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant102547NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1198486OTHERNCMEDCOST

General Provider Information

NPI Number : 1356424501
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAN ECCLESTONE PA-C
Provider Business Mailing Address
First Line : 200 WELLESLEY TRADE LN
Second Line :
City : CARY
State : NC
Zip : 27519-5576
Country : US
Telephone Number : 919-363-7546
Fax Number : 919-363-3616
Provider Business Practice Location Address
First Line : 200 WELLESLEY TRADE LN
Second Line :
City : CARY
State : NC
Zip : 27519-5576
Country : US
Telephone Number : 919-363-7546
Fax Number : 919-363-3616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 08/29/2014

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Directions to “ DAN ECCLESTONE PA-C” Practice Location

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