Provider Demographics
NPI:1215968763
Name:SERPE, EUGENE CARMELO (PA-C)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:CARMELO
Last Name:SERPE
Suffix:
Gender:M
Credentials:PA-C
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 405633
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5633
Mailing Address - Country:US
Mailing Address - Phone:336-623-7881
Mailing Address - Fax:
Practice Address - Street 1:518 S VAN BUREN RD
Practice Address - Street 2:STE 3
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5033
Practice Address - Country:US
Practice Address - Phone:336-623-7881
Practice Address - Fax:336-623-5457
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P04541Medicare UPIN
NC2752815Medicare ID - Type UnspecifiedMEDICARE