Basic Information
| Provider Information | |||||||||
| NPI: | 1578597670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBERT | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 470 | ||||||||
| Address2: | |||||||||
| City: | MILLERS CREEK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286510470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366518948 | ||||||||
| FaxNumber: | 3366518948 | ||||||||
| Practice Location | |||||||||
| Address1: | 204 OLD BRICKYARD ROAD | ||||||||
| Address2: | |||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366672020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 04/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9700838 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 202012836 | 01 | NC | TAX I.D. # | OTHER | 891058R | 05 | NC | MEDICAID |