Edenton Internal Medicine PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

EDENTON INTERNAL MEDICINE PA

Practice address

104 Mark Dr
Edenton, NC 27932-1756

Phone

(252) 482-5171

Fax

(252) 482-5173

NPI assigned

Oct 27, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joseph Ray Haskett Jr., MDNPI 1669461729

Title

President

Phone

(252) 482-5171

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph Ray Haskett Jr., MD

  • Internal Medicine Physician
  • Edenton, NC
  • NPI 1669461729
  NPD Authorized official
• John Stafford Taylor, MD

  • Internal Medicine Physician
  • Edenton, NC
  • NPI 1932198090
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104816396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1210",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321210",
            "telephone_number": "252-482-5171",
            "fax_number": "252-482-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MARK DR",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321756",
            "telephone_number": "252-482-5171",
            "fax_number": "252-482-5173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENTON INTERNAL MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HASKETT",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-482-5171",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890127H",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• East Carolina Health-Chowan Inc
• East Carolina Health-Chowan Inc
• East Carolina Health-Chowan Inc.
• Eastern Dermatology PA
• Edenton House, LLC
• Edenton Operating Al, LLC
• Edenton Prime Time Retirement Village, LLC
• Edenton Retirement Community, LLC
• Edenton Urology Clinic
• Edenton-Chowan Schools

• Internal Medicine Physician in Edenton, NC
• Providers in Edenton, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.