Provider Demographics
NPI:1346486891
Name:SEASIDE PEDIATRICS
Entity Type:Organization
Organization Name:SEASIDE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:O
Authorized Official - Last Name:HORGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-452-1999
Mailing Address - Street 1:1606 WELLINGTON AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7747
Mailing Address - Country:US
Mailing Address - Phone:910-452-1999
Mailing Address - Fax:910-452-1883
Practice Address - Street 1:1606 WELLINGTON AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7747
Practice Address - Country:US
Practice Address - Phone:910-452-1999
Practice Address - Fax:910-452-1883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8943705Medicaid