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General NPI Number Information
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NPI Number | 1902887292
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Entity Type | Organization
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Legal Business Name | KINSTON DIAGNOSTIC GROUP PA
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 109 AIRPORT ROAD
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City | KINSTON
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State | NC
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Zip | 28501-1693
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Country | US
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Telephone | 252-522-3661
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Fax | 252-522-0117
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Provider Business Mailing Address
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Address Line | 109 AIRPORT ROAD
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City | KINSTON
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State | NC
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Zip | 28501-1693
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Country | US
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Telephone | 252-522-3661
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Fax | 252-522-0117
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE HARPER WEST
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Credential | MD
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Telephone | 252-522-3661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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