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General NPI Number Information
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NPI Number | 1417338054
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Entity Type | Organization
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Legal Business Name | EAC MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 704 BRUSHY MOUNTAIN RD
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9349
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Country | US
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Telephone | 866-720-1214
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Fax |
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Provider Business Mailing Address
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Address Line | 704 BRUSHY MOUNTAIN RD
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-9349
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHUKWUDI E OGBOLU
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Credential | MD
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Telephone | 866-720-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD421052
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License Number State | PA
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