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General NPI Number Information
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NPI Number | 1144101643
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Entity Type | Individual
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Provider Name | MR. ERIC JUSTIN MASTRIDGE
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Gender | Male
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 78 WHEATON AVE
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-8691
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Country | US
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Telephone | 919-529-2474
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Fax | 919-529-2143
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Provider Business Mailing Address
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Address Line | 78 WHEATON AVE
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City | YOUNGSVILLE
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State | NC
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Zip | 27596-8691
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Country | US
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Telephone | 919-529-2474
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Fax | 919-529-2143
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State | NC
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