Healthcare Provider Details

I. General information

NPI: 1437121431
Provider Name (Legal Business Name): VIRGINIA R ALBANO DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 HENDERSON DR
JACKSONVILLE NC
28546-5237
US

IV. Provider business mailing address

3701 HENDERSON DR
JACKSONVILLE NC
28546-5237
US

V. Phone/Fax

Practice location:
  • Phone: 910-346-2700
  • Fax: 910-346-0824
Mailing address:
  • Phone: 910-346-2700
  • Fax: 910-346-0824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number199
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number199
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: