MEDICARE: DR. DAVID BEAUCHAMP EDDLEMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2005-00035	NC

General Provider Information

NPI Number	:	1114927126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BEAUCHAMP EDDLEMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 31323
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27622-1323
Country	:	US
Telephone Number	:	919-782-8210
Fax Number	:	919-781-4650

Provider Business Practice Location Address
First Line	:	2800 BLUE RIDGE RD
Second Line	:	SUITE 503
City	:	RALEIGH
State	:	NC
Zip	:	27607-6478
Country	:	US
Telephone Number	:	919-782-8210
Fax Number	:	919-781-4650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	03/29/2021

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