Provider Demographics
NPI:1073126223
Name:KING PODIATRY AND ASSOCIATES PLLC
Entity Type:Organization
Organization Name:KING PODIATRY AND ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAINIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-338-2111
Mailing Address - Street 1:1121 N ROAD ST STE B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3470
Mailing Address - Country:US
Mailing Address - Phone:252-338-2111
Mailing Address - Fax:
Practice Address - Street 1:5116 N CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3988
Practice Address - Country:US
Practice Address - Phone:252-338-2111
Practice Address - Fax:252-338-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty