Healthcare Provider Details

I. General information

NPI: 1063499796
Provider Name (Legal Business Name): SEAN THOMAS CANALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL SUITE 211
RALEIGH NC
27607-7513
US

IV. Provider business mailing address

4414 LAKE BOONE TRL SUITE 211
RALEIGH NC
27607-7513
US

V. Phone/Fax

Practice location:
  • Phone: 919-741-5966
  • Fax: 919-571-4330
Mailing address:
  • Phone: 919-741-5966
  • Fax: 919-571-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number021219
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: