Basic Information
| Provider Information | |||||||||
| NPI: | 1932572039 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RAJABIROSTAMI | ||||||||
| FirstName: | EHSAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | SENTARA ALBEMARLE MEDICAL CENTER, 1144 N ROAD ST, | ||||||||
| Address2: | SENTARA ALBEMARLE MEDICAL CENTER | ||||||||
| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27909 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1144 N ROAD ST | ||||||||
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| City: | ELIZABETH CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279093473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473164000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2015 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101274401 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0101274401 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 2018-02778 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.