Provider Demographics
NPI:1568576213
Name:ARCHER, NOAH R JR (MD)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:R
Last Name:ARCHER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-3300
Mailing Address - Fax:910-341-3321
Practice Address - Street 1:2421 SILVER STREAM LANE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-0000
Practice Address - Country:US
Practice Address - Phone:910-763-2072
Practice Address - Fax:910-763-1586
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC35255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1228864OtherUHC
NC561980160X7OtherCIGNA
NC11952OtherBCBS NC
NC8911952Medicaid
NC89465OtherMEDCOST
NC8911952Medicaid
NC8911952Medicaid