Provider Demographics
NPI:1962446773
Name:EASTERN ALLERGY, ASTHMA AND IMMUNOLOGY, PA
Entity type:Organization
Organization Name:EASTERN ALLERGY, ASTHMA AND IMMUNOLOGY, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIROLLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-523-5461
Mailing Address - Street 1:PO BOX 1073
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503-1073
Mailing Address - Country:US
Mailing Address - Phone:252-523-5461
Mailing Address - Fax:252-523-0471
Practice Address - Street 1:905 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3943
Practice Address - Country:US
Practice Address - Phone:252-523-5461
Practice Address - Fax:252-523-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty