Provider Demographics
NPI:1801813456
Name:PARTNERS IN ENDOCRINOLOGY AND DIABETES PLLC
Entity Type:Organization
Organization Name:PARTNERS IN ENDOCRINOLOGY AND DIABETES PLLC
Other - Org Name:PED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:BRYSON
Authorized Official - Last Name:LEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-762-6481
Mailing Address - Street 1:1501 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7506
Mailing Address - Country:US
Mailing Address - Phone:910-762-6481
Mailing Address - Fax:910-762-9705
Practice Address - Street 1:1501 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7506
Practice Address - Country:US
Practice Address - Phone:910-762-6481
Practice Address - Fax:910-762-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401253261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC019P4OtherBLUE CROSS BLUE SHIELD NC
NC019P4OtherBLUE CROSS BLUE SHIELD NC