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General NPI Number Information
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NPI Number | 1336185842
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Entity Type | Organization
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Legal Business Name | EASTERN ENT SINUS AND ALLERGY CENTER, PA
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 02/08/2010
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Provider Practice Location Address
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Address Line | 2707 MEDICAL OFFICE PL
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City | GOLDSBORO
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State | NC
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Zip | 27534-9458
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Country | US
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Telephone | 919-735-9146
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Fax | 919-735-0582
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Provider Business Mailing Address
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Address Line | 2707 MEDICAL OFFICE PL
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City | GOLDSBORO
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State | NC
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Zip | 27534-9458
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Country | US
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Telephone | 919-735-9146
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Fax | 919-735-0582
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DAWN MCCULLEN
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Credential |
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Telephone | 919-735-9146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number |
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License Number State |
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