Provider Demographics
NPI:1437219979
Name:EASTERN CAROLINA PEDIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:EASTERN CAROLINA PEDIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MORRISON
Authorized Official - Last Name:FARISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-395-0015
Mailing Address - Street 1:PO BOX 799
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29540-0799
Mailing Address - Country:US
Mailing Address - Phone:843-395-0015
Mailing Address - Fax:843-395-2573
Practice Address - Street 1:105 INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-0000
Practice Address - Country:US
Practice Address - Phone:843-395-0015
Practice Address - Fax:843-395-2573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC067Medicaid
SC423968Medicare Oscar/Certification