Healthcare Provider Details

I. General information

NPI: 1083387831
Provider Name (Legal Business Name): ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 LUKE ST STE D
EDENTON NC
27932-9680
US

IV. Provider business mailing address

701 LUKE ST STE D
EDENTON NC
27932-9680
US

V. Phone/Fax

Practice location:
  • Phone: 252-337-9170
  • Fax: 757-837-4731
Mailing address:
  • Phone: 252-337-9170
  • Fax: 757-837-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DORIS PRINCE
Title or Position: DIRECTOR
Credential:
Phone: 757-983-5475