Provider Demographics
NPI:1396704813
Name:CHOWAN FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:CHOWAN FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-482-6522
Mailing Address - Street 1:701 LUKE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-9643
Mailing Address - Country:US
Mailing Address - Phone:252-482-6522
Mailing Address - Fax:252-482-6534
Practice Address - Street 1:701 LUKE ST
Practice Address - Street 2:SUITE D
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9643
Practice Address - Country:US
Practice Address - Phone:252-482-6522
Practice Address - Fax:252-482-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2013-06-20
Deactivation Date:2010-03-26
Deactivation Code:
Reactivation Date:2012-01-26
Provider Licenses
StateLicense IDTaxonomies
NC26142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89011P1Medicaid
NC26142OtherSTATE LICENSE #
NC89011P1Medicaid