Provider Demographics
NPI:1447263678
Name:KATHERINE MCNEESE MD PA
Entity type:Organization
Organization Name:KATHERINE MCNEESE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-789-4001
Mailing Address - Street 1:108 TRADE ST
Mailing Address - Street 2:P.O. BOX 1659
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-7008
Mailing Address - Country:US
Mailing Address - Phone:252-789-4001
Mailing Address - Fax:252-799-0204
Practice Address - Street 1:108 TRADE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-7008
Practice Address - Country:US
Practice Address - Phone:252-789-4001
Practice Address - Fax:252-799-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344853Medicare PIN