Provider Demographics
NPI:1245375443
Name:EDWARD B EADIE JR MD WOMENS UROLOGY
Entity type:Organization
Organization Name:EDWARD B EADIE JR MD WOMENS UROLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:EADIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-338-0101
Mailing Address - Street 1:1141 N ROAD ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3354
Mailing Address - Country:US
Mailing Address - Phone:252-338-0101
Mailing Address - Fax:252-331-1598
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:SUITE I
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3354
Practice Address - Country:US
Practice Address - Phone:252-338-0101
Practice Address - Fax:252-331-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTRICARE ID NUMBER