Provider Demographics
NPI:1780677237
Name:SEMBLE, ELLIOTT L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:L
Last Name:SEMBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 BETHESDA RD STE C
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3300
Mailing Address - Country:US
Mailing Address - Phone:336-659-4585
Mailing Address - Fax:336-659-4548
Practice Address - Street 1:751 BETHESDA RD STE C
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3300
Practice Address - Country:US
Practice Address - Phone:336-659-4585
Practice Address - Fax:336-659-4548
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2021-02-26
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
NC24946174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC86386Medicare UPIN