Provider Demographics
NPI:1598852360
Name:REGISTER, AMBER J (PA C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:J
Last Name:REGISTER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W WENDOVER AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-333-9111
Mailing Address - Fax:336-333-2042
Practice Address - Street 1:1305 W WENDOVER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-333-9111
Practice Address - Fax:336-333-2042
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103645207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00041375OtherRR MEDICARE
P92751Medicare UPIN
P00041375OtherRR MEDICARE