Healthcare Provider Details

I. General information

NPI: 1811168008
Provider Name (Legal Business Name): SARI EAPEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 HWY 125
ROANOKE RAPIDS NC
27870-6455
US

IV. Provider business mailing address

257 HWY 125
ROANOKE RAPIDS NC
27870-6455
US

V. Phone/Fax

Practice location:
  • Phone: 252-410-0001
  • Fax: 252-410-0003
Mailing address:
  • Phone: 252-410-0001
  • Fax: 252-410-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number26226
License Number StateNC

VIII. Authorized Official

Name: SARI G EAPEN
Title or Position: OWNER
Credential: MD
Phone: 252-410-0001