Healthcare Provider Details

I. General information

NPI: 1114126489
Provider Name (Legal Business Name): EAST COAST IMAGING ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WIDGEON DR
HAMPSTEAD NC
28443-2436
US

IV. Provider business mailing address

301 WIDGEON DR
HAMPSTEAD NC
28443-2436
US

V. Phone/Fax

Practice location:
  • Phone: 910-270-2108
  • Fax:
Mailing address:
  • Phone: 910-270-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number32236
License Number StateNC

VIII. Authorized Official

Name: DR. JOSEPH WILLIAM FISCHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 910-270-2108