Provider Demographics
NPI:1811204431
Name:ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity type:Organization
Organization Name:ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-252-2765
Mailing Address - Street 1:1134 N ROAD ST
Mailing Address - Street 2:BLDG 2
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:252-679-7388
Mailing Address - Fax:252-679-7673
Practice Address - Street 1:1134 N ROAD ST
Practice Address - Street 2:BLDG 2
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:252-679-7388
Practice Address - Fax:252-679-7673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207K00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23473398BMedicare PIN