Provider Demographics
NPI:1740331164
Name:AZALEA GYNECOLOGY PA
Entity type:Organization
Organization Name:AZALEA GYNECOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOVOSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-452-3666
Mailing Address - Street 1:1814 NEW HANOVER MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5350
Mailing Address - Country:US
Mailing Address - Phone:910-452-3666
Mailing Address - Fax:910-397-0930
Practice Address - Street 1:736 MEDICAL CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4250
Practice Address - Country:US
Practice Address - Phone:910-452-3666
Practice Address - Fax:910-397-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty