Provider Demographics
NPI:1902993710
Name:EAST COAST MEDICAL PLLC
Entity Type:Organization
Organization Name:EAST COAST MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:910-329-0300
Mailing Address - Street 1:22545B HWY 17 N
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:910-329-0300
Mailing Address - Fax:910-329-0307
Practice Address - Street 1:22545B HWY 17 N
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443
Practice Address - Country:US
Practice Address - Phone:910-329-0300
Practice Address - Fax:910-329-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39512173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC183715OtherMEDCOST GROUP
NCP00310136OtherRAILROAD MEDICARE
NC5901781Medicaid
NC017N3OtherBLUE CROSS GROUP
NC=========OtherUNITED HEALTH CARE
NCP00310136OtherRAILROAD MEDICARE
NC017N3OtherBLUE CROSS GROUP
NCG26850Medicare UPIN