Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 26226 | NC |
NPI | 1881693778 |
---|---|
Provider Name | Sari George Eapen |
First Address | Roanoke Rapids, NC 27870-2935 |
Second Address | Roanoke Rapids, NC 27870-2935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 07/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5900284 | (05) | NC |
B08056 | (02) | NC |
P00378382 | RAILROAD MEDICARE (01) |