MEDICARE: AMY RUTH CSORBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	29249	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093835084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY RUTH CSORBA

Provider Business Mailing Address
First Line	:	3001 ACADEMY RD
Second Line	:	SUITE 200
City	:	DURHAM
State	:	NC
Zip	:	27707-2660
Country	:	US
Telephone Number	:	919-403-8600
Fax Number	:	919-489-8585

Provider Business Practice Location Address
First Line	:	3001 ACADEMY RD
Second Line	:	SUITE 200
City	:	DURHAM
State	:	NC
Zip	:	27707-2660
Country	:	US
Telephone Number	:	919-403-8600
Fax Number	:	919-489-8585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2007
Last Update Date	:	07/08/2007

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