Provider Demographics
NPI:1902817240
Name:EUSEBIO, JOSE ES (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ES
Last Name:EUSEBIO
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 W GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3824
Practice Address - Country:US
Practice Address - Phone:980-487-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700940207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1074WOtherBCBS
SCN00940Medicaid
NC891074WMedicaid
NC1902817240Medicaid
P00200640OtherRAILROAD MEDICARE
F44954Medicare UPIN
NC2245586DMedicare PIN
NCNC2168AMedicare PIN
NCNC2335AMedicare PIN
NC891074WMedicaid
NCNC2168BMedicare PIN