Provider Demographics
NPI:1841285293
Name:ALBEMARLE EAR NOSE & THROAT ASTHMA AND ALLERGY ASSOCIATES PA
Entity type:Organization
Organization Name:ALBEMARLE EAR NOSE & THROAT ASTHMA AND ALLERGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DONOHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-335-2923
Mailing Address - Street 1:1134 N ROAD ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:252-335-2923
Mailing Address - Fax:252-335-7003
Practice Address - Street 1:1134 N ROAD ST
Practice Address - Street 2:BLDG # 2
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:252-335-2923
Practice Address - Fax:252-335-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Y00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902953Medicaid
2326014DMedicare ID - Type Unspecified