Provider Demographics
NPI:1942360185
Name:NEWBERN MEDICAL ARTS PHCY INC
Entity type:Organization
Organization Name:NEWBERN MEDICAL ARTS PHCY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARM AND MGR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:252-638-6131
Mailing Address - Street 1:1916 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-2320
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1916 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-2320
Practice Address - Country:US
Practice Address - Phone:252-638-6131
Practice Address - Fax:252-638-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC027043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0255208Medicaid
NC7700249Medicaid
3400861OtherOTHER ID NUMBER