Healthcare Provider Details

I. General information

NPI: 1265903256
Provider Name (Legal Business Name): ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 03/19/2019
Certification Date:
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: 252-337-9440
  • Fax: 252-384-9997
Mailing address:
  • Phone: 252-337-9440
  • Fax: 252-384-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY A TAYLOR
Title or Position: PROJECT MANAGER
Credential:
Phone: 757-252-2765