Provider Demographics
NPI:1427141142
Name:ROSADO, EDDIE ALBERTO (PA-C)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:ALBERTO
Last Name:ROSADO
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 1:1303 AZALEA CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5765
Mailing Address - Country:US
Mailing Address - Phone:843-467-2676
Mailing Address - Fax:843-497-9566
Practice Address - Street 1:722 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5238
Practice Address - Country:US
Practice Address - Phone:843-467-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104073363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCB057AMedicare PIN
NCNCB057BMedicare PIN
NC2762898Medicare PIN