Healthcare Provider Details

I. General information

NPI: 1043264724
Provider Name (Legal Business Name): EASTERN CAROLINA CARDIOVASCULAR, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N ROAD ST BLDG.9
ELIZABETH CITY NC
27909-3365
US

IV. Provider business mailing address

1134 N ROAD ST BLDG.9
ELIZABETH CITY NC
27909-3365
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-9451
  • Fax: 252-338-9170
Mailing address:
  • Phone: 252-338-9451
  • Fax: 252-338-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY L WHITE
Title or Position: PRESIDENT
Credential: MD
Phone: 252-338-9451