Provider Demographics
NPI:1114927126
Name:EDDLEMAN, DAVID BEAUCHAMP (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BEAUCHAMP
Last Name:EDDLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31323
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27622-1323
Mailing Address - Country:US
Mailing Address - Phone:919-782-8210
Mailing Address - Fax:919-781-4650
Practice Address - Street 1:2800 BLUE RIDGE RD
Practice Address - Street 2:SUITE 503
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6478
Practice Address - Country:US
Practice Address - Phone:919-782-8210
Practice Address - Fax:919-781-4650
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00035208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2041243Medicare PIN
NC2041243BMedicare PIN
I32478Medicare UPIN