Provider Demographics
NPI:1598757916
Name:ALBEMARLE MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:ALBEMARLE MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF INTERNAL MEDICINE / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEJWANT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:CHANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-335-2963
Mailing Address - Street 1:1507 N ROAD ST
Mailing Address - Street 2:STE 3
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-335-2963
Mailing Address - Fax:252-335-2636
Practice Address - Street 1:1507 N ROAD ST
Practice Address - Street 2:STE 3
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-2963
Practice Address - Fax:252-335-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1049618OtherFIRST HEALTH
011F5OtherBCBS OF NC
295434OtherMAMSI
111692OtherSENTARA
29476OtherSENTARA
96698OtherMEDCOST
110213096OtherRAILROAD MEDICARE
432487OtherBCBS OF VA (TRIGON)
NC89011F5Medicaid
7203205OtherCIGNA
NC891170CMedicaid
PR72032050001OtherCIGNA
26741OtherPARTNERS
96698OtherMEDCOST
=========OtherTRICARE
=========0001OtherCIGNA
PR72032050001OtherCIGNA
1049618OtherFIRST HEALTH
=========OtherTRICARE
2261582AMedicare ID - Type Unspecified