Healthcare Provider Details

I. General information

NPI: 1629292776
Provider Name (Legal Business Name): AMY V ISENBERG M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 INDEPENDENCE BLVD STE 200
WILMINGTON NC
28412-2482
US

IV. Provider business mailing address

1602 PHYSICIANS DR STE 104
WILMINGTON NC
28401-7350
US

V. Phone/Fax

Practice location:
  • Phone: 910-442-1100
  • Fax: 910-442-1199
Mailing address:
  • Phone: 910-442-1100
  • Fax: 910-442-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number200300249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: