MEDICARE: ALBEMARLE NEUROLOGY, P. A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9900827	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12159	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932253630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBEMARLE NEUROLOGY, P. A.

Provider Business Mailing Address
First Line	:	110 MEDICAL DR
Second Line	:	SUITE 5
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3374
Country	:	US
Telephone Number	:	252-331-1188
Fax Number	:	252-335-9920

Provider Business Practice Location Address
First Line	:	110 MEDICAL DR
Second Line	:	SUITE 5
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3374
Country	:	US
Telephone Number	:	252-331-1188
Fax Number	:	252-335-9920

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. PAMELA SUE EVANS
Credential	:	M.D.
Telephone Number	:	252-331-1188

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	09/06/2007

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