Basic Information
| Provider Information | |||||||||
| NPI: | 1831169291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUENVIAJE | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | MARTIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751274 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751274 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 PROFESSIONAL PARK STE A | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275652580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196933972 | ||||||||
| FaxNumber: | 9196931700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101235137 | VA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2012-01204 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.