Provider Demographics
NPI:1235308065
Name:HALIFAX NORTHAMPTON INTERNAL MEDICINE, PA
Entity Type:Organization
Organization Name:HALIFAX NORTHAMPTON INTERNAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-537-0077
Mailing Address - Street 1:244 SMITH CHURCH RD STE D
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4957
Mailing Address - Country:US
Mailing Address - Phone:252-537-0077
Mailing Address - Fax:252-537-9689
Practice Address - Street 1:244 SMITH CHURCH RD STE D
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4957
Practice Address - Country:US
Practice Address - Phone:252-537-0077
Practice Address - Fax:252-537-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890175NMedicaid
NC890175NMedicaid
NCE39633Medicare UPIN