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General NPI Number Information
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NPI Number | 1649233883
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Entity Type | Individual
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Provider Name | JEANE M CASSELBERRY MD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 324 N QUEEN ST
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City | KINSTON
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State | NC
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Zip | 28501-4932
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Country | US
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Telephone | 252-522-9800
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Fax | 252-523-9790
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Provider Business Mailing Address
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Address Line | 324 N QUEEN ST
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City | KINSTON
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State | NC
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Zip | 28501-4932
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Country | US
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Telephone | 252-522-9800
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Fax | 252-523-9790
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2019-02540
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301053890
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01080999A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 4301053890
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License Number State | MI
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