Provider Demographics
NPI:1922180504
Name:SUMNERS, ANN C (M D)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:C
Last Name:SUMNERS
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:MANTEO
Mailing Address - State:NC
Mailing Address - Zip Code:27954-1045
Mailing Address - Country:US
Mailing Address - Phone:252-473-3478
Mailing Address - Fax:252-473-3600
Practice Address - Street 1:604 AMANDA ST
Practice Address - Street 2:
Practice Address - City:MANTEO
Practice Address - State:NC
Practice Address - Zip Code:27954-9039
Practice Address - Country:US
Practice Address - Phone:252-473-3478
Practice Address - Fax:252-473-3600
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902933Medicaid
NC0751030001Medicare NSC
NC2039813Medicare PIN
NC5902933Medicaid