Provider Demographics
NPI:1851897292
Name:SEAL, EMILY KATHRYN (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:SEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KATHRYN
Other - Last Name:SEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:612 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2732
Mailing Address - Country:US
Mailing Address - Phone:704-210-5308
Mailing Address - Fax:704-637-1121
Practice Address - Street 1:1910 JAKE ALEXANDER BLVD W STE 102
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1163
Practice Address - Country:US
Practice Address - Phone:704-210-7670
Practice Address - Fax:704-637-1121
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2022-02178208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC310461OtherNC MEDICAL LICENSE
NCFS2041654OtherDEA