MEDICARE: EASTERN MEDICAL ASSOCIATES, PA

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CI3418	OTHER	NC	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922045673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN MEDICAL ASSOCIATES, PA

Provider Business Mailing Address
First Line	:	5413 US HIGHWAY 117 N
Second Line	:
City	:	PIKEVILLE
State	:	NC
Zip	:	27863-9445
Country	:	US
Telephone Number	:	919-242-5271
Fax Number	:	919-242-5096

Provider Business Practice Location Address
First Line	:	5413 US HIGHWAY 117 N
Second Line	:
City	:	PIKEVILLE
State	:	NC
Zip	:	27863-9445
Country	:	US
Telephone Number	:	919-242-5271
Fax Number	:	919-242-5096

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PHILIP DOUGLAS MAYO
Credential	:	M.D.
Telephone Number	:	919-734-1779

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/04/2008

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Directions to “EASTERN MEDICAL ASSOCIATES, PA ” Practice Location

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