Provider Demographics
NPI:1659334837
Name:ALBEMARLE AREA UROLOGY, PC
Entity Type:Organization
Organization Name:ALBEMARLE AREA UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:EADIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-338-3600
Mailing Address - Street 1:1134 N ROAD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:252-338-3600
Mailing Address - Fax:252-338-8673
Practice Address - Street 1:1134 N ROAD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:252-338-3600
Practice Address - Fax:252-338-8673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90176208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC011Y2OtherBLUE CROSS
NC89011Y2Medicaid
NC011Y2OtherBLUE CROSS