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General NPI Number Information
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NPI Number | 1093904278
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Entity Type | Organization
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Legal Business Name | MED CAREEAST P A
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 2485 HEMBY LN D
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City | GREENVILLE
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State | NC
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Zip | 27834-3733
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Country | US
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Telephone | 252-758-5888
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Fax | 252-758-9888
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Provider Business Mailing Address
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Address Line | 1425 EAST FIRETOWER ROAD 100
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City | GREENVILLE
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State | NC
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Zip | 27858-4131
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Country | US
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Telephone | 252-758-5888
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Fax | 252-758-9888
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MS. REGINA L HATHAWAY
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Credential | FNP
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Telephone | 252-758-5888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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