Provider Demographics
NPI:1366495822
Name:NEIJSTROM, ERIC SHERWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SHERWOOD
Last Name:NEIJSTROM
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 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:336-623-9713
Mailing Address - Fax:336-623-1031
Practice Address - Street 1:516 S VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5019
Practice Address - Country:US
Practice Address - Phone:336-623-9713
Practice Address - Fax:336-623-1031
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23630207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4915OtherPARTNERS MEDICARE
NC62064OtherBCBS NC
NC28621OtherMEDCOST
NC4318942OtherAETNA
NC8962064Medicaid
NC209140CMedicare ID - Type UnspecifiedMEDICARE
NC4915OtherPARTNERS MEDICARE