Provider Demographics
NPI:1396725065
Name:NORTHEASTERN OB/GYN, LTD
Entity type:Organization
Organization Name:NORTHEASTERN OB/GYN, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-338-0101
Mailing Address - Street 1:1009 CROSSWINDS DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6341
Mailing Address - Country:US
Mailing Address - Phone:252-330-2082
Mailing Address - Fax:252-331-1598
Practice Address - Street 1:1141 N ROAD ST
Practice Address - Street 2:SUITE I
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3354
Practice Address - Country:US
Practice Address - Phone:252-338-0101
Practice Address - Fax:252-331-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1514Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER