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General NPI Number Information
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NPI Number | 1043702889
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Entity Type | Organization
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Legal Business Name | CYNTHIA VAIL, PA-C, PA
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 1509 E ASH ST
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City | GOLDSBORO
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State | NC
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Zip | 27530-5203
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Country | US
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Telephone | 919-778-8551
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Fax | 919-734-1297
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Provider Business Mailing Address
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Address Line | 412 HOLLY BERRY LN
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City | SELMA
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State | NC
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Zip | 27576-5514
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Country | US
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Telephone | 207-831-0617
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CYNTHIA S VAIL
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Credential | PA-C
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Telephone | 207-831-0617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 101668
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License Number State | NC
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