Provider Demographics
NPI:1073663910
Name:ALBEMARLE GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ALBEMARLE GASTROENTEROLOGY ASSOCIATES
Other - Org Name:STEVEN M. FABER MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-335-5588
Mailing Address - Street 1:405 HASTINGS LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3327
Mailing Address - Country:US
Mailing Address - Phone:252-335-5588
Mailing Address - Fax:252-335-9498
Practice Address - Street 1:405 HASTINGS LN
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3327
Practice Address - Country:US
Practice Address - Phone:252-335-5588
Practice Address - Fax:252-335-9498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35892174400000X
NC35982261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2319928OtherMCARE PROVIDER NUMBER
NC35892OtherNC LICENSE #
NC100004991OtherRR MEDICARE PTAN
NC0131YOtherBLUE CROSS GROUP #
NC35892OtherNC LICENSE #