Provider Demographics
NPI:1679643142
Name:SABISTON, WALTER ROBERTS
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ROBERTS
Last Name:SABISTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-3746
Mailing Address - Country:US
Mailing Address - Phone:252-223-6700
Mailing Address - Fax:
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1584
Practice Address - Country:US
Practice Address - Phone:252-523-0687
Practice Address - Fax:252-523-0255
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15574207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC406041204OtherMEDICARE RAILROAD
NC897134Medicaid
NC406041204OtherMEDICARE RAILROAD
NC897134Medicaid