Provider Demographics
NPI:1518961937
Name:RICE, EASTON MARTIN III (DHSC, MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:EASTON
Middle Name:MARTIN
Last Name:RICE
Suffix:III
Gender:M
Credentials:DHSC, MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TANNER WOODS LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9758
Mailing Address - Country:US
Mailing Address - Phone:864-554-7565
Mailing Address - Fax:
Practice Address - Street 1:1704 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7905
Practice Address - Country:US
Practice Address - Phone:336-373-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA493363A00000X
NC0010-02312363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0283PAMedicaid
SCS648978189Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
SC0283PAMedicaid