Provider Demographics
NPI:1003231556
Name:EAST CAROLINA UNIVERSITY BRODY SCHOOL OF MEDICINE
Entity type:Organization
Organization Name:EAST CAROLINA UNIVERSITY BRODY SCHOOL OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN, BRODY SCHOOL OF MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:282-744-2201
Mailing Address - Street 1:1709 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2803
Mailing Address - Country:US
Mailing Address - Phone:252-744-5990
Mailing Address - Fax:252-744-2813
Practice Address - Street 1:1709 W 6TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2803
Practice Address - Country:US
Practice Address - Phone:252-744-5990
Practice Address - Fax:252-744-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0745364Medicaid