Provider Demographics
NPI:1245255488
Name:EAST CAROLINA MEDICAL ASSOCIATES P.C
Entity type:Organization
Organization Name:EAST CAROLINA MEDICAL ASSOCIATES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ABAYOMI
Authorized Official - Middle Name:WILKINS
Authorized Official - Last Name:OSUNKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-353-4878
Mailing Address - Street 1:PO BOX 12549
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-2549
Mailing Address - Country:US
Mailing Address - Phone:910-353-4878
Mailing Address - Fax:910-353-2258
Practice Address - Street 1:25 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-353-4878
Practice Address - Fax:910-353-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101258207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2308221Medicare PIN
NCG45378Medicare UPIN