Provider Demographics
NPI:1356398994
Name:NASH INTERNAL MEDICINE PA
Entity type:Organization
Organization Name:NASH INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMILLA
Authorized Official - Middle Name:ALLYN
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-443-2552
Mailing Address - Street 1:3009 ZEBULON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2422
Mailing Address - Country:US
Mailing Address - Phone:252-443-2552
Mailing Address - Fax:252-443-0936
Practice Address - Street 1:3009 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2422
Practice Address - Country:US
Practice Address - Phone:252-443-2552
Practice Address - Fax:252-443-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15996207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890175 AMedicaid
NC0175AOtherBCBS
NC0175AOtherBCBS
C80743Medicare UPIN