Healthcare Provider Details

I. General information

NPI: 1831155415
Provider Name (Legal Business Name): SEASIDE INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 N LAKE PARK BLVD SUITE 106
CAROLINA BEACH NC
28428-3945
US

IV. Provider business mailing address

PO BOX 311
CAROLINA BEACH NC
28428-0311
US

V. Phone/Fax

Practice location:
  • Phone: 910-458-5750
  • Fax: 910-458-5770
Mailing address:
  • Phone: 910-458-5750
  • Fax: 910-458-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: MS. SARA L CHRISTIANSEN
Title or Position: OWNER MEDICAL DIRECTOR
Credential: MD
Phone: 910-458-5750