Basic Information
Provider Information
NPI: 1063469179
EntityType: 2
ReplacementNPI:  
OrganizationName: CARDIAC THORACIC & VASCULAR ASSOCIATES OF EASTERN CAROLINA PLLC
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Mailing Information
Address1: 960 NEWMAN RD
Address2:  
City: NEW BERN
State: NC
PostalCode: 285625200
CountryCode: US
TelephoneNumber: 2526336730
FaxNumber: 2526336740
Practice Location
Address1: 960 NEWMAN RD
Address2:  
City: NEW BERN
State: NC
PostalCode: 28562
CountryCode: US
TelephoneNumber: 2526336730
FaxNumber: 2526336740
Other Information
ProviderEnumerationDate: 05/27/2006
LastUpdateDate: 12/23/2011
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: HALLIGAN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: EDWARD
AuthorizedOfficialTitleorPosition: MEMBER MANAGER
AuthorizedOfficialTelephone: 2526336730
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208G00000X9700577NCY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 

ID Information
IDTypeStateIssuerDescription
018CH01NCBCBSOTHER
590432905NC MEDICAID


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