Provider Demographics
NPI:1548214976
Name:BOUNOUS, EDWIN PHILLIP JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:PHILLIP
Last Name:BOUNOUS
Suffix:JR
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 12248
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2248
Mailing Address - Country:US
Mailing Address - Phone:252-634-9090
Mailing Address - Fax:252-634-9915
Practice Address - Street 1:730 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5238
Practice Address - Country:US
Practice Address - Phone:252-634-9090
Practice Address - Fax:252-634-9915
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC17082OtherBCBS OF NC
NC8917082Medicaid
NC8917082Medicaid
NC110158086Medicare PIN
NC204912EMedicare PIN
NC17082OtherBCBS OF NC