Provider Demographics
NPI:1578686804
Name:ELDRIDGE, MARK (PA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:4702 SAINT GEORGES DR N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-9176
Mailing Address - Country:US
Mailing Address - Phone:252-237-2891
Mailing Address - Fax:252-237-0115
Practice Address - Street 1:1725 TARBORO ST SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3428
Practice Address - Country:US
Practice Address - Phone:252-237-2891
Practice Address - Fax:252-237-0115
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC101816363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMEO382820OtherDEA #