Healthcare Provider Details

I. General information

NPI: 1912949439
Provider Name (Legal Business Name): PAMLICO INTERNAL MEDICINE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 HIGHLAND DR
WASHINGTON NC
27889
US

IV. Provider business mailing address

1314 HIGHLAND DR
WASHINGTON NC
27889
US

V. Phone/Fax

Practice location:
  • Phone: 252-948-0101
  • Fax: 252-974-5464
Mailing address:
  • Phone: 252-948-0101
  • Fax: 252-974-5464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS W NICHOLSON
Title or Position: PRESIDENT
Credential: MD
Phone: 252-946-2101