Provider Demographics
NPI:1063499796
Name:CANALE, SEAN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:THOMAS
Last Name:CANALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 211
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-741-5966
Mailing Address - Fax:919-571-4330
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:SUITE 211
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-741-5966
Practice Address - Fax:919-571-4330
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021219208600000X
NC208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7998996OtherCIGNA
NC89128K6Medicaid
NC128K6OtherBCBS
BC4895213OtherDEA
G23088Medicare UPIN