Provider Demographics
NPI:1124165659
Name:ALBEMARLE ALLERGY & ASTHMA, PC
Entity type:Organization
Organization Name:ALBEMARLE ALLERGY & ASTHMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-338-0373
Mailing Address - Street 1:410 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4495
Mailing Address - Country:US
Mailing Address - Phone:252-338-0373
Mailing Address - Fax:
Practice Address - Street 1:410 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4495
Practice Address - Country:US
Practice Address - Phone:252-338-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72895207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0139JOtherBCBS GROUP NUMBER
NC6983580Medicaid
NC2198828BMedicare ID - Type UnspecifiedKITTY HAWK NC OFFICE
NC2198828AMedicare ID - Type UnspecifiedELIZABETH CITY NC OFFICE
NC6983580Medicaid