Provider Demographics
NPI:1417083783
Name:EASTERN NEPHROLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:EASTERN NEPHROLOGY ASSOCIATES PLLC
Other - Org Name:KENDRICK, NEWMAN, BYRUM AND HOGGARD
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATRONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-390-7973
Mailing Address - Street 1:511 PALADIN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7826
Mailing Address - Country:US
Mailing Address - Phone:252-752-8880
Mailing Address - Fax:252-752-3084
Practice Address - Street 1:511 PALADIN DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7826
Practice Address - Country:US
Practice Address - Phone:252-752-8880
Practice Address - Fax:252-752-3084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC230715BMedicare ID - Type UnspecifiedNEW BERN OFFICE GRP NO.
NC230715AMedicare ID - Type UnspecifiedKINSTON OFFICE GRP NO.