Provider Demographics
NPI:1598873515
Name:ALBEMARLE FOOT SPECIALISTS
Entity Type:Organization
Organization Name:ALBEMARLE FOOT SPECIALISTS
Other - Org Name:THOMAS P. WHITFIELD DPM
Other - Org Type:Other Name
Authorized Official - Title/Position:MOA/INSURANCE PROVESSOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TROUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-394-4980
Mailing Address - Street 1:4016 WILKSON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 N THIRD ST
Practice Address - Street 2:ALBEMARLE FOOT SPECIALISTS
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-983-3177
Practice Address - Fax:704-392-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
012EJOtherPROVIDER ID NUMBER