Provider Demographics
NPI:1891997334
Name:EAST CAROLINA PSYCHIATRIC CONSULTANTS,PLLC
Entity Type:Organization
Organization Name:EAST CAROLINA PSYCHIATRIC CONSULTANTS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTHIAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SABANAYAGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-735-9119
Mailing Address - Street 1:916 ELEVENTH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1616
Mailing Address - Country:US
Mailing Address - Phone:919-735-9119
Mailing Address - Fax:919-735-9120
Practice Address - Street 1:916 ELEVENTH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1616
Practice Address - Country:US
Practice Address - Phone:919-735-9119
Practice Address - Fax:919-735-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC316392084P0800X, 2084P0802X, 2084P0804X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE61101OtherHUMANA
NC019JVOtherBCBS
NC5909195Medicaid
NC019JVOtherBCBS
NCE36114Medicare UPIN
NE61101OtherHUMANA