Basic Information
| Provider Information | |||||||||
| NPI: | 1053509653 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE DOCTORS OFFICE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15409 | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285615409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526727741 | ||||||||
| FaxNumber: | 2526727758 | ||||||||
| Practice Location | |||||||||
| Address1: | 7901 EMERALD DR | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | EMERALD ISLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285942846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523546500 | ||||||||
| FaxNumber: | 2523545060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 12/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | VIRGINIA | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2523546500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1053509653 | 01 | NC | BCBS | OTHER | 5908353 | 05 | NC | MEDICAID |