Provider Demographics
NPI:1689342263
Name:UROLOGY ASSOCIATES OF SOUTHEASTERN NORTH CAROLINA, PA
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF SOUTHEASTERN NORTH CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASQUARELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-763-6251
Mailing Address - Street 1:1905 GLEN MEADE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6024
Mailing Address - Country:US
Mailing Address - Phone:910-763-6251
Mailing Address - Fax:910-763-7408
Practice Address - Street 1:4222 LONG BEACH RD SE STE B
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8627
Practice Address - Country:US
Practice Address - Phone:910-763-6251
Practice Address - Fax:910-763-7408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY ASSOCIATES OF SOUTHEASTERN NORTH CAROLINA, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty