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General NPI Number Information
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NPI Number | 1669708665
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Entity Type | Organization
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Legal Business Name | MID ATLANTIC NEUROLOGY & SLEEP MEDICINE, P.A.
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Dates
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Enumeration Date | 10/26/2009
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Last Update Date | 10/26/2009
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Provider Practice Location Address
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Address Line | 227 MEMORIAL DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6333
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Country | US
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Telephone | 910-353-3624
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Fax | 910-353-0050
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Provider Business Mailing Address
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Address Line | PO BOX 12067
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City | NEW BERN
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State | NC
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Zip | 28561-2067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KHALED F JREISAT
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Credential | MD
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Telephone | 252-474-3863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) 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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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