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NPI Code Detail

MEDICARE: DR. GREGORY LAWTON EAVES M.D.

MEDICARE: DR. GREGORY LAWTON EAVES M.D.
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
1207RC0000XCardiovascular Disease Physician18256SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487737821
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY LAWTON EAVES M.D.
Provider Business Mailing Address
First Line : 367 S. GULPH RD
Second Line : ATT: IPM CREDENTIALING
City : KING OF PRUSSIA
State : PA
Zip : 19406-3121
Country : US
Telephone Number : 803-641-4874
Fax Number :
Provider Business Practice Location Address
First Line : 137 MIRACLE DR
Second Line :
City : AIKEN
State : SC
Zip : 29801-6351
Country : US
Telephone Number : 803-641-4874
Fax Number : 803-641-0436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2006
Last Update Date : 03/07/2019

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