Organization
EDENTON INTERNAL MEDICINE PA
Active
Organization
EDENTON INTERNAL MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH RAY HASKETT JR. MD (PRESIDENT)
(252) 482-5171
Entity
Organization
Contact information
Practice address
104 MARK DR, EDENTON, NC 27932-1756
(252) 482-5171
(252) 482-5173
Mailing address
PO BOX 1210, EDENTON, NC 27932-1210
(252) 482-5171
(252) 482-5173
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890127H
—
NC
Enumeration date
10/27/2005
Last updated
08/22/2020
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