Provider Demographics
NPI:1033291174
Name:ALBEMARLE UROLOGY CLINIC PA
Entity type:Organization
Organization Name:ALBEMARLE UROLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:PASTORINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-982-5150
Mailing Address - Street 1:923 N SECOND ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001
Mailing Address - Country:US
Mailing Address - Phone:704-982-5150
Mailing Address - Fax:704-982-5181
Practice Address - Street 1:923 N SECOND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:704-982-5150
Practice Address - Fax:704-982-5181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0141JOtherBCBS
NC2343422Medicare ID - Type UnspecifiedINDIVIDUAL
0141JOtherBCBS
NC203734BMedicare ID - Type UnspecifiedGROUP