Healthcare Provider Details

I. General information

NPI: 1609162023
Provider Name (Legal Business Name): ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 MEDICAL DR
ELIZABETH CITY NC
27909-3361
US

IV. Provider business mailing address

112 MEDICAL DR
ELIZABETH CITY NC
27909-3361
US

V. Phone/Fax

Practice location:
  • Phone: 252-384-2610
  • Fax: 252-338-2505
Mailing address:
  • Phone: 252-384-2610
  • Fax: 252-338-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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