Provider Demographics
NPI:1376752618
Name:EASTERN ONCOLOGY & HEMATOLOGY
Entity Type:Organization
Organization Name:EASTERN ONCOLOGY & HEMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-830-1867
Mailing Address - Street 1:855 JOHNS HOPKINS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7223
Mailing Address - Country:US
Mailing Address - Phone:252-830-1867
Mailing Address - Fax:252-830-1003
Practice Address - Street 1:855 JOHNS HOPKINS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7223
Practice Address - Country:US
Practice Address - Phone:252-830-1867
Practice Address - Fax:252-830-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34779207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901828Medicaid
NC830006019OtherMEDICARE RR
NC01828OtherBCBS
NC36-56186OtherUNITED HEALTHCARE
NCG23846Medicare UPIN
NC2241911AMedicare PIN