Healthcare Provider Details

I. General information

NPI: 1962719609
Provider Name (Legal Business Name): ALBEMARLE PHYSICIAN SERVICES - SENTARA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 N ROAD ST
ELIZABETH CITY NC
27909-3388
US

IV. Provider business mailing address

1177 N ROAD ST
ELIZABETH CITY NC
27909-3388
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 Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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