1598757916 NPI number — ALBEMARLE MEDICAL ASSOCIATES PLLC

Table of content: (NPI 1598757916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598757916 NPI number — ALBEMARLE MEDICAL ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBEMARLE MEDICAL ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598757916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1507 N ROAD ST
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
ELIZABETH CITY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-335-2963
Provider Business Mailing Address Fax Number:
252-335-2636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1507 N ROAD ST
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
ELIZABETH CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-335-2963
Provider Business Practice Location Address Fax Number:
252-335-2636
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHANDI
Authorized Official First Name:
TEJWANT
Authorized Official Middle Name:
SINGH
Authorized Official Title or Position:
DOCTOR OF INTERNAL MEDICINE / OWNER
Authorized Official Telephone Number:
252-335-2963

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  9701713 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1049618 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 011F5 . This is a "BCBS OF NC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 295434 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 111692 . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29476 . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 96698 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110213096 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 432487 . This is a "BCBS OF VA (TRIGON)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89011F5 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7203205 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 891170C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: PR72032050001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26741 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".




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