Provider Demographics
NPI:1992797856
Name:NORTHEAST OBGYN ASSOCIATES PA
Entity type:Organization
Organization Name:NORTHEAST OBGYN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OVERCASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-788-4151
Mailing Address - Street 1:1054 BURRAGE RD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2910
Mailing Address - Country:US
Mailing Address - Phone:704-788-4151
Mailing Address - Fax:704-788-4150
Practice Address - Street 1:1054 BURRAGE RD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2910
Practice Address - Country:US
Practice Address - Phone:704-788-4151
Practice Address - Fax:704-788-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty