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General NPI Number Information
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NPI Number | 1811024979
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Entity Type | Organization
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Legal Business Name | EASTERN PEDIATRICS, P.A.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1901 STONEHENGE DR
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City | GREENVILLE
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State | NC
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Zip | 27858-5067
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Country | US
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Telephone | 252-561-7777
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Fax | 252-561-7778
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Provider Business Mailing Address
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Address Line | 1901 STONEHENGE DR
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City | GREENVILLE
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State | NC
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Zip | 27858-5067
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Country | US
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Telephone | 252-561-7777
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Fax | 252-561-7778
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Authorized Official
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Title or Position | ADMINISTRATIVE/FINANCIAL SUPERVISOR
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Name | MRS. YOICHA G RAY
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Credential |
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Telephone | 252-561-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 970062
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License Number State | NC
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