Provider Demographics
NPI:1629199385
Name:HUEDA, ELIZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:
Last Name:HUEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 ARROWHEAD BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7637
Mailing Address - Country:US
Mailing Address - Phone:919-304-5900
Mailing Address - Fax:919-304-5901
Practice Address - Street 1:3940 ARROWHEAD BLVD
Practice Address - Street 2:BUILDING A SUITE 210
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7636
Practice Address - Country:US
Practice Address - Phone:919-904-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119940208000000X
390200000X
NC2010-01858208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17136OtherBLUE CROSS
FL279005000Medicaid
FL17136OtherBLUE CROSS