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Organization
SALEM PEDIATRIC EAR AND AIRWAY CENTER, PLLC
Active
Organization
SALEM PEDIATRIC EAR AND AIRWAY CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADELE KAREN EVANS MD (MEMBER MANAGER)
(919) 699-2269
Entity
Organization
Contact information
Practice address
615 SAINT GEORGE SQUARE CT, SUITE 364, WINSTON SALEM, NC 27103-1356
(336) 245-4972
(336) 450-1676
Mailing address
615 SAINT GEORGE SQUARE CT, SUITE 364, WINSTON SALEM, NC 27103-1356
(336) 245-4972
(336) 450-1676
Taxonomy
Speciality
Code
Description
License number
State
207YP0228X
Pediatric Otolaryngology Physician
Primary
2006-00303
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760414866
—
NC
Enumeration date
03/08/2016
Last updated
03/08/2016
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