Healthcare Provider Details

I. General information

NPI: 1780677237
Provider Name (Legal Business Name): ELLIOTT L SEMBLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date: 03/23/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

751 BETHESDA RD STE C
WINSTON SALEM NC
27103-3300
US

IV. Provider business mailing address

751 BETHESDA RD STE C
WINSTON SALEM NC
27103-3300
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-4585
  • Fax: 336-659-4548
Mailing address:
  • Phone: 336-659-4585
  • Fax: 336-659-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number24946
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number24946
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: