Provider Demographics
NPI:1588665970
Name:KINSTON PULMONARY ASSOCIATES PA
Entity Type:Organization
Organization Name:KINSTON PULMONARY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GALLAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-527-9800
Mailing Address - Street 1:706 ROSEANNE DR
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-1550
Mailing Address - Country:US
Mailing Address - Phone:252-527-9800
Mailing Address - Fax:252-527-8353
Practice Address - Street 1:706 ROSEANNE DR
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-1550
Practice Address - Country:US
Practice Address - Phone:252-527-9800
Practice Address - Fax:252-527-8353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2344378Medicare ID - Type UnspecifiedGROUP