Provider Demographics
NPI:1720600380
Name:ESSIG, JEREMIAH JOSPEH (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JOSPEH
Last Name:ESSIG
Suffix:
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 1:114 MELVILLE LOOP APT 11
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-6922
Mailing Address - Country:US
Mailing Address - Phone:484-955-0468
Mailing Address - Fax:
Practice Address - Street 1:102 MASON FARM RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4617
Practice Address - Country:US
Practice Address - Phone:984-974-4462
Practice Address - Fax:919-843-9355
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261609390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program