Provider Demographics
NPI:1093835084
Name:CSORBA, AMY RUTH
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH
Last Name:CSORBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 ACADEMY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2660
Mailing Address - Country:US
Mailing Address - Phone:919-403-8600
Mailing Address - Fax:919-489-8585
Practice Address - Street 1:3001 ACADEMY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2660
Practice Address - Country:US
Practice Address - Phone:919-403-8600
Practice Address - Fax:919-489-8585
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8926435Medicaid
NC8926435Medicaid
NC204202HMedicare ID - Type Unspecified