Healthcare Provider Details

I. General information

NPI: 1447228994
Provider Name (Legal Business Name): ALVIN P KITCHIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E ASHE ST
WADESBORO NC
28170-2702
US

IV. Provider business mailing address

PO BOX 473
WADESBORO NC
28170-0473
US

V. Phone/Fax

Practice location:
  • Phone: 704-694-5188
  • Fax: 704-694-9067
Mailing address:
  • Phone: 704-694-5188
  • Fax: 704-694-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13478
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: