Provider Demographics
NPI:1851689558
Name:ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type:Organization
Organization Name:ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Other - Org Name:SENTARA PEDIATRIC PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-252-2765
Mailing Address - Street 1:1141 N ROAD ST
Mailing Address - Street 2:STE M
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-384-2590
Mailing Address - Fax:252-384-2589
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:STE M
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-384-2590
Practice Address - Fax:252-384-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2347339Medicare PIN