Healthcare Provider Details

I. General information

NPI: 1801551965
Provider Name (Legal Business Name): NORTHSTAR MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7779 NC HIGHWAY 68 N STE 2A
STOKESDALE NC
27357-9496
US

IV. Provider business mailing address

7779 NC HIGHWAY 68 N STE 2A
STOKESDALE NC
27357-9496
US

V. Phone/Fax

Practice location:
  • Phone: 336-298-7557
  • Fax: 336-298-7551
Mailing address:
  • Phone: 336-298-7557
  • Fax: 336-298-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RALPH CARTER BOBBITT JR.
Title or Position: CO-OWNER
Credential: MD
Phone: 336-298-7557