Healthcare Provider Details

I. General information

NPI: 1306478763
Provider Name (Legal Business Name): SALEM RHEUMATOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BETHESDA RD
WINSTON SALEM NC
27103-3300
US

IV. Provider business mailing address

751 BETHESDA RD
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 TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLIOTT L SEMBLE
Title or Position: OWNER
Credential: MD
Phone: 336-659-4585