Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 2002-00194 | NC |
NPI | 1164480927 |
---|---|
Provider Name | Dr. John G. Albertini |
First Address | Winston Salem, NC 27103-1300 |
Second Address | Winston Salem, NC 27103-1300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 13/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89131X5 | (05) | NC |
G25125 | (02) | NC |