Provider Demographics
NPI:1215928403
Name:SEVERA, JEFFREY F (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:F
Last Name:SEVERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BAY POINT DR
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-8032
Mailing Address - Country:US
Mailing Address - Phone:252-209-3690
Mailing Address - Fax:252-482-5061
Practice Address - Street 1:105 MARK DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1704
Practice Address - Country:US
Practice Address - Phone:252-482-3047
Practice Address - Fax:252-482-5061
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137KROtherBCBS NC
NC89137KRMedicaid
NC89137KRMedicaid
NC137KROtherBCBS NC