=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427173996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTCOAST DIAGNOSTICS & SLEEP CENTERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 09/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3520 TORINGDON WAY SUITE 103
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28277-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-341-2247
-----------------------------------------------------
Fax | 704-341-2248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 10487
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28404-0487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-200-9932
-----------------------------------------------------
Fax | 910-686-8673
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN W CROMER JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 910-200-9932
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------