Provider Demographics
NPI:1982775037
Name:VERRILLI, ALBERT ALEXANDER III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:ALEXANDER
Last Name:VERRILLI
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2650
Mailing Address - Country:US
Mailing Address - Phone:910-590-3397
Mailing Address - Fax:910-592-1334
Practice Address - Street 1:603 BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2650
Practice Address - Country:US
Practice Address - Phone:910-590-3397
Practice Address - Fax:910-592-1334
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7985058Medicaid
NC7985058Medicaid
NC211179-CMedicare PIN