Healthcare Provider Details

I. General information

NPI: 1174526123
Provider Name (Legal Business Name): EDWARD WILLIAM HOEHN-SARIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 OLMSTED BLVD STE 7
PINEHURST NC
28374-9191
US

IV. Provider business mailing address

293 OLMSTED BLVD STE 7
PINEHURST NC
28374-9191
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-3344
  • Fax: 910-295-3165
Mailing address:
  • Phone: 910-295-3344
  • Fax: 910-295-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number9700591
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8910692
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: