Provider Demographics
NPI:1457432973
Name:KINSTON PODIATRY CENTER
Entity Type:Organization
Organization Name:KINSTON PODIATRY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DELANEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:252-523-7070
Mailing Address - Street 1:402 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8226
Mailing Address - Country:US
Mailing Address - Phone:252-523-7070
Mailing Address - Fax:252-523-9315
Practice Address - Street 1:402 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8226
Practice Address - Country:US
Practice Address - Phone:252-523-7070
Practice Address - Fax:252-523-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC387213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79-0800EMedicaid
NC2433080-AMedicare ID - Type Unspecified
NC79-0800EMedicaid