Provider Demographics
NPI:1720071103
Name:SEO, ESTHER E (MD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:E
Last Name:SEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:919-620-4917
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:7021 HARPS MILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3240
Practice Address - Country:US
Practice Address - Phone:919-845-2125
Practice Address - Fax:919-845-2152
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109635207R00000X
NC2009-01515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109635Medicaid
L99242Medicare ID - Type Unspecified
IL036109635Medicaid
NC2075148Medicare PIN