Provider Demographics
NPI:1861555799
Name:ALBEMARLE NEPHROLOGY PLLC
Entity type:Organization
Organization Name:ALBEMARLE NEPHROLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:252-335-1083
Mailing Address - Street 1:206 HASTINGS LANE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3324
Mailing Address - Country:US
Mailing Address - Phone:252-335-1083
Mailing Address - Fax:252-335-4030
Practice Address - Street 1:206 HASTINGS LANE
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3324
Practice Address - Country:US
Practice Address - Phone:252-335-1083
Practice Address - Fax:252-335-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138840207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDF7627OtherRAIL ROAD MEDICARE
NC018R4OtherBLUE CROSS BLUE SHIELD
NC890109FMedicaid
NC018R4OtherBLUE CROSS BLUE SHIELD