Provider Demographics
NPI:1437343621
Name:TARBORO INTERNAL MEDICINE OF NORTH CAROLINA, PA
Entity Type:Organization
Organization Name:TARBORO INTERNAL MEDICINE OF NORTH CAROLINA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:EVERLYN
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-823-0808
Mailing Address - Street 1:2704-C NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2704
Mailing Address - Country:US
Mailing Address - Phone:252-823-0808
Mailing Address - Fax:252-823-6010
Practice Address - Street 1:2704-C NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2704
Practice Address - Country:US
Practice Address - Phone:252-823-0808
Practice Address - Fax:252-823-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001464895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO3424OtherMEDICARE RAILROAD
NC5900019Medicaid
NC020E2OtherBCBS
NC4213840OtherCIGNA
NC4213840OtherCIGNA