Provider Demographics
NPI:1891798799
Name:ALBERT, DEBORAH LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOUISE
Last Name:ALBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PENNSYLVANIA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3389
Mailing Address - Country:US
Mailing Address - Phone:304-388-1770
Mailing Address - Fax:304-388-1775
Practice Address - Street 1:830 PENNSYLVANIA AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3389
Practice Address - Country:US
Practice Address - Phone:304-388-1770
Practice Address - Fax:304-388-1775
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV276232086S0120X
NC2009-020922086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1891798799Medicaid
FL064806000Medicaid
NC5916046Medicaid
SCQ02092Medicaid
FLC12651Medicare UPIN
NC1891798799Medicaid
SCQ02092Medicaid