Provider Demographics
NPI:1154383461
Name:DEAN, ERIC L (MD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:L
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13118
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3118
Mailing Address - Country:US
Mailing Address - Phone:336-954-1007
Mailing Address - Fax:336-954-1183
Practice Address - Street 1:1409 YANCEYVILLE ST
Practice Address - Street 2:SUITE C
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6960
Practice Address - Country:US
Practice Address - Phone:336-954-1007
Practice Address - Fax:336-954-1183
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0172WOtherBCBS ID #
NC7927976Medicaid
NC890172WMedicaid
NC25680OtherSTATE LICENSE #
NCAD1344744OtherDEA #
NC25680OtherSTATE LICENSE #
NC7927976Medicaid