Provider Demographics
NPI:1811024979
Name:EASTERN PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:EASTERN PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE/FINANCIAL SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOICHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-561-7777
Mailing Address - Street 1:1901 STONEHENGE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5067
Mailing Address - Country:US
Mailing Address - Phone:252-561-7777
Mailing Address - Fax:252-561-7778
Practice Address - Street 1:1901 STONEHENGE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5067
Practice Address - Country:US
Practice Address - Phone:252-561-7777
Practice Address - Fax:252-561-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC970062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950204Medicaid
NC2348101OtherMEDICARE