Provider Demographics
NPI:1336136837
Name:ELINE, EUGENE ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ANTHONY
Last Name:ELINE
Suffix:
Gender:M
Credentials:DO
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-216-5633
Mailing Address - Fax:704-639-0785
Practice Address - Street 1:1910 JAKE ALEXANDER BLVD W STE 202
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1165
Practice Address - Country:US
Practice Address - Phone:704-603-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00139207X00000X
PAOS005975L207X00000X, 207XS0117X, 207XX0801X
GA048622207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024920600001Medicaid
MD037247100Medicaid
PA181569FLTMedicare PIN
PA1589291OtherGATEWAY-WMG
MD967228-01OtherCAREFIRST MD BCBS-WMG
PA2508842OtherHIGHMARK BLUE SHIELD
PA181569FLTMedicare PIN
PA30078789OtherAMERIHEALTH MERCY-WMG
PA1024920600001Medicaid