Provider Demographics
NPI:1609831015
Name:CHOWAN MEDICAL CENTER, PA
Entity Type:Organization
Organization Name:CHOWAN MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIMARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-482-2116
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0429
Mailing Address - Country:US
Mailing Address - Phone:252-482-2116
Mailing Address - Fax:252-482-4874
Practice Address - Street 1:201 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9668
Practice Address - Country:US
Practice Address - Phone:252-482-2116
Practice Address - Fax:252-482-4874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01310OtherBCBS PROVIDER #
NC8901310Medicaid
NC8901310Medicaid