Provider Demographics
NPI:1831155415
Name:SEASIDE INTERNAL MEDICINE PLLC
Entity type:Organization
Organization Name:SEASIDE INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-458-5750
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-0311
Mailing Address - Country:US
Mailing Address - Phone:910-458-5750
Mailing Address - Fax:910-458-5770
Practice Address - Street 1:1328 N LAKE PARK BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-3945
Practice Address - Country:US
Practice Address - Phone:910-458-5750
Practice Address - Fax:910-458-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC138XPOtherBCBS
NC5900288Medicaid
2344201Medicare ID - Type Unspecified
NC5900288Medicaid