Healthcare Provider Details

I. General information

NPI: 1285683060
Provider Name (Legal Business Name): EAST CAROLINA UNIVERSTIY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRODY OUTPATIENT CENTER 600 MOYE BLVD
GREENVILLE NC
27858
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-2207
  • Fax: 252-744-3472
Mailing address:
  • Phone: 252-744-3253
  • Fax: 252-744-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS BENSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 252-744-3253