Healthcare Provider Details

I. General information

NPI: 1598836645
Provider Name (Legal Business Name): ALBERT A VERRILLI MD,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 BEAMAN ST
CLINTON NC
28328-2650
US

IV. Provider business mailing address

603 BEAMAN ST
CLINTON NC
28328-2650
US

V. Phone/Fax

Practice location:
  • Phone: 910-590-3397
  • Fax: 910-592-1334
Mailing address:
  • Phone: 910-590-3397
  • Fax: 910-592-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29511
License Number StateNC

VIII. Authorized Official

Name: DR. ALBERT ALEXANDER VERRILLI III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 910-590-3397