Provider Demographics
NPI:1437121431
Name:ALBANO, VIRGINIA R (DPM)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:R
Last Name:ALBANO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5237
Mailing Address - Country:US
Mailing Address - Phone:910-346-2700
Mailing Address - Fax:910-346-0824
Practice Address - Street 1:3701 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5237
Practice Address - Country:US
Practice Address - Phone:910-346-2700
Practice Address - Fax:910-346-0824
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC199213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0808ROtherBCBS
NC08044OtherBCBS
NC8908044Medicaid
NC08000OtherBCBS
NC8908000Medicaid
NC890808RMedicaid
NC243112AMedicare ID - Type Unspecified
NC08044OtherBCBS
NC0808ROtherBCBS
NCT64070Medicare UPIN