Provider Demographics
NPI:1932253630
Name:ALBEMARLE NEUROLOGY, P. A.
Entity type:Organization
Organization Name:ALBEMARLE NEUROLOGY, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-331-1188
Mailing Address - Street 1:110 MEDICAL DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3374
Mailing Address - Country:US
Mailing Address - Phone:252-331-1188
Mailing Address - Fax:252-335-9920
Practice Address - Street 1:110 MEDICAL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3374
Practice Address - Country:US
Practice Address - Phone:252-331-1188
Practice Address - Fax:252-335-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12159OtherBCBS
NC8912159Medicaid
NCG99055Medicare UPIN
NC12159OtherBCBS