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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