Provider Demographics
NPI:1821054339
Name:NORTHEASTERN ORTHOPEDICS, PA
Entity Type:Organization
Organization Name:NORTHEASTERN ORTHOPEDICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:STEVENSON
Authorized Official - Last Name:LARABEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-332-3699
Mailing Address - Street 1:602 ACADEMY ST S
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3239
Mailing Address - Country:US
Mailing Address - Phone:252-332-3699
Mailing Address - Fax:252-332-4335
Practice Address - Street 1:602 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3239
Practice Address - Country:US
Practice Address - Phone:252-332-3699
Practice Address - Fax:252-332-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88829207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011MROtherBLUE CROSS OF NC GROUP NU
NC89011MRMedicaid
NC011MROtherBLUE CROSS OF NC GROUP NU