Healthcare Provider Details

I. General information

NPI: 1336185842
Provider Name (Legal Business Name): EASTERN ENT SINUS AND ALLERGY CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9458
US

IV. Provider business mailing address

2707 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9458
US

V. Phone/Fax

Practice location:
  • Phone: 919-735-9146
  • Fax: 919-735-0582
Mailing address:
  • Phone: 919-735-9146
  • Fax: 919-735-0582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAWN MCCULLEN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 919-735-9146