Provider Demographics
NPI:1942263751
Name:EASTSIDE PEDIATRICS PA
Entity Type:Organization
Organization Name:EASTSIDE PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-292-8868
Mailing Address - Street 1:4501 OLD SPARTANBURG RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-4105
Mailing Address - Country:US
Mailing Address - Phone:864-292-8868
Mailing Address - Fax:864-331-0992
Practice Address - Street 1:4501 OLD SPARTANBURG RD
Practice Address - Street 2:SUITE 9
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-4105
Practice Address - Country:US
Practice Address - Phone:864-292-8868
Practice Address - Fax:864-331-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty