Healthcare Provider Details

I. General information

NPI: 1073663910
Provider Name (Legal Business Name): ALBEMARLE GASTROENTEROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HASTINGS LN
ELIZABETH CITY NC
27909-3327
US

IV. Provider business mailing address

405 HASTINGS LN
ELIZABETH CITY NC
27909-3327
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-5588
  • Fax: 252-335-9498
Mailing address:
  • Phone: 252-335-5588
  • Fax: 252-335-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number35982
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35892
License Number StateNC

VIII. Authorized Official

Name: DR. STEVEN M FABER
Title or Position: PRESIDENT
Credential: M.D
Phone: 252-335-5588