Provider Demographics
NPI:1942267943
Name:KINSTON OBSTETRICAL & GYNECOLOGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:KINSTON OBSTETRICAL & GYNECOLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-522-4333
Mailing Address - Street 1:KINSTON CLINIC NORTH
Mailing Address - Street 2:SUITE E DOCTORS DRIVE
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1598
Mailing Address - Country:US
Mailing Address - Phone:252-522-4333
Mailing Address - Fax:252-522-2951
Practice Address - Street 1:KINSTON CLINIC NORTH
Practice Address - Street 2:SUITE E DOCTORS DRIVE
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1598
Practice Address - Country:US
Practice Address - Phone:252-522-4333
Practice Address - Fax:252-522-2951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901963Medicaid
NC230169Medicare ID - Type Unspecified