Provider Demographics
NPI:1942252341
Name:CAROLINA EAST FAMILY MEDICINE
Entity Type:Organization
Organization Name:CAROLINA EAST FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHRSDORDFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-756-3713
Mailing Address - Street 1:3282 CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8875
Mailing Address - Country:US
Mailing Address - Phone:252-756-3713
Mailing Address - Fax:252-756-5920
Practice Address - Street 1:3282 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8875
Practice Address - Country:US
Practice Address - Phone:252-756-3713
Practice Address - Fax:252-756-5920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016RKMedicaid
NC22648Medicare UPIN
NC89016RKMedicaid