Healthcare Provider Details

I. General information

NPI: 1073693347
Provider Name (Legal Business Name): EASTERN CAROLINA PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 MEDICAL PARK DR W
WILSON NC
27893-2705
US

IV. Provider business mailing address

1702 MEDICAL PARK DR W
WILSON NC
27893-2705
US

V. Phone/Fax

Practice location:
  • Phone: 252-243-7944
  • Fax: 252-243-6097
Mailing address:
  • Phone: 252-243-7944
  • Fax: 252-243-6097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier890120E
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name: LINDA M DAVIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-243-7944