Healthcare Provider Details

I. General information

NPI: 1578597670
Provider Name (Legal Business Name): SUSAN L. ALBERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 OLD BRICKYARD ROAD
NORTH WILKESBORO NC
28659
US

IV. Provider business mailing address

PO BOX 470
MILLERS CREEK NC
28651-0470
US

V. Phone/Fax

Practice location:
  • Phone: 336-667-2020
  • Fax:
Mailing address:
  • Phone: 336-651-8948
  • Fax: 336-651-8948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9700838
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: