Provider Demographics
NPI:1851897292
Name:SEAL, EMILY KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHRYN
Last Name:SEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KATHRYN
Other - Last Name:SEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2554 LEWISVILLE CLEMMONS RD STE 201
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8749
Mailing Address - Country:US
Mailing Address - Phone:336-986-9537
Mailing Address - Fax:804-203-7002
Practice Address - Street 1:2554 LEWISVILLE CLEMMONS RD STE 201
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8749
Practice Address - Country:US
Practice Address - Phone:336-986-9537
Practice Address - Fax:804-203-7002
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-02178208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC310461OtherNC MEDICAL LICENSE
NCFS2041654OtherDEA