Provider Demographics
NPI:1629292776
Name:ISENBERG, AMY V (MD, MPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:V
Last Name:ISENBERG
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 PHYSICIANS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7350
Mailing Address - Country:US
Mailing Address - Phone:910-442-1100
Mailing Address - Fax:910-442-1199
Practice Address - Street 1:2520 INDEPENDENCE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2482
Practice Address - Country:US
Practice Address - Phone:910-442-1100
Practice Address - Fax:910-442-1199
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300249207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2021613AOtherMEDICARE ID
NC2021613DOtherMEDICARE PTAN
NC5907212Medicaid
NC2021613BOtherMEDICARE PTAN
NC2021613AOtherMEDICARE ID
NC1992708747Medicare PIN