Basic Information
| Provider Information | |||||||||
| NPI: | 1366495822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEIJSTROM | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | SHERWOOD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366239713 | ||||||||
| FaxNumber: | 3366231031 | ||||||||
| Practice Location | |||||||||
| Address1: | 516 S VAN BUREN RD | ||||||||
| Address2: | |||||||||
| City: | EDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272885019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366239713 | ||||||||
| FaxNumber: | 3366231031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 23630 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RX0202X | 23630 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 4915 | 01 | NC | PARTNERS MEDICARE | OTHER | 62064 | 01 | NC | BCBS NC | OTHER | 28621 | 01 | NC | MEDCOST | OTHER | 4318942 | 01 | NC | AETNA | OTHER | 8962064 | 05 | NC | MEDICAID |