Provider Demographics
NPI:1629179650
Name:ALBALA, NATALIE LAURA (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LAURA
Last Name:ALBALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:L
Other - Last Name:ALBALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1080 FIRST COLONIAL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2406
Mailing Address - Country:US
Mailing Address - Phone:757-395-6630
Mailing Address - Fax:
Practice Address - Street 1:1080 FIRST COLONIAL RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2406
Practice Address - Country:US
Practice Address - Phone:757-395-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401163207R00000X
SC37984207R00000X
VA0101267071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891373MMedicaid
NC1373MOtherBC/BS OF NC
SC379842Medicaid
NCP00165862OtherMEDICARE RAILROAD
NCP00165862OtherMEDICARE RAILROAD
SC379842Medicaid
NC2034368AMedicare PIN
SCSC5727Medicare PIN