Provider Demographics
NPI:1831169291
Name:BUENVIAJE, ERIC MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MARTIN
Last Name:BUENVIAJE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751274
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 PROFESSIONAL PARK STE A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2580
Practice Address - Country:US
Practice Address - Phone:919-693-3972
Practice Address - Fax:919-693-1700
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235137207Q00000X
NC2012-01204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine