Provider Demographics
NPI:1710919055
Name:HEALY, EDWARD JAMES (PAC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:HEALY
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1134 N ROAD ST STE 9
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:252-338-9451
Mailing Address - Fax:252-338-9170
Practice Address - Street 1:1134 N ROAD ST STE 9
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:252-338-9451
Practice Address - Fax:252-338-9170
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103623363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant