Healthcare Provider Details

I. General information

NPI: 1811204431
Provider Name (Legal Business Name): ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 N ROAD ST BLDG 2
ELIZABETH CITY NC
27909-3365
US

IV. Provider business mailing address

1134 N ROAD ST BLDG 2
ELIZABETH CITY NC
27909-3365
US

V. Phone/Fax

Practice location:
  • Phone: 252-679-7388
  • Fax: 252-679-7673
Mailing address:
  • Phone: 252-679-7388
  • Fax: 252-679-7673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNC

VIII. Authorized Official

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