Provider Demographics
NPI:1922140169
Name:DIABETES & ENDOCRINOLOGY CONSULTANTS PC
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINOLOGY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-222-5700
Mailing Address - Street 1:623 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3126
Mailing Address - Country:US
Mailing Address - Phone:252-222-5700
Mailing Address - Fax:252-222-5705
Practice Address - Street 1:623 N 35TH ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3126
Practice Address - Country:US
Practice Address - Phone:252-222-5700
Practice Address - Fax:252-222-5705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25724207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126CRMedicaid
NC2337005Medicare ID - Type UnspecifiedGROUP NUMBER