Provider Demographics
NPI:1154332815
Name:WARD, ERIC VAUGHN (DPM)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:VAUGHN
Last Name:WARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 SENNA DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6722
Mailing Address - Country:US
Mailing Address - Phone:704-845-2920
Mailing Address - Fax:704-845-2921
Practice Address - Street 1:2950 SENNA DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6722
Practice Address - Country:US
Practice Address - Phone:704-845-2920
Practice Address - Fax:704-845-2921
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC259213E00000X, 213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012J7OtherBCBS
SCNPD259Medicaid
NC6712460028OtherMEDICARE PTAN
NC890915GMedicaid
NCT64095Medicare UPIN
NC6212890001Medicare NSC
NC6712460028Medicare NSC
NC6712460028OtherMEDICARE PTAN