Healthcare Provider Details

I. General information

NPI: 1811024979
Provider Name (Legal Business Name): EASTERN PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/09/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 STONEHENGE DR
GREENVILLE NC
27858-5067
US

IV. Provider business mailing address

1901 STONEHENGE DR
GREENVILLE NC
27858-5067
US

V. Phone/Fax

Practice location:
  • Phone: 252-561-7777
  • Fax: 252-561-7778
Mailing address:
  • Phone: 252-561-7777
  • Fax: 252-561-7778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number970062
License Number StateNC

VIII. Authorized Official

Name: MRS. YOICHA G RAY
Title or Position: ADMINISTRATIVE/FINANCIAL SUPERVISOR
Credential:
Phone: 252-561-7777