Healthcare Provider Details

I. General information

NPI: 1467466276
Provider Name (Legal Business Name): EASTCOAST DIAGNOSTICS & SLEEP CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 OWEN DR SUITE 103
FAYETTEVILLE NC
28304-1611
US

IV. Provider business mailing address

PO BOX 10487
WILMINGTON NC
28404-0487
US

V. Phone/Fax

Practice location:
  • Phone: 910-860-8378
  • Fax: 910-860-8379
Mailing address:
  • Phone: 910-200-9932
  • Fax: 910-686-8693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN WILLARD CROMER JR.
Title or Position: PARTNER
Credential: MD
Phone: 910-860-8378