Basic Information
| Provider Information | |||||||||
| NPI: | 1093835084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CSORBA | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | RUTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 ACADEMY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277072660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194038600 | ||||||||
| FaxNumber: | 9194898585 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 ACADEMY RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277072660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194038600 | ||||||||
| FaxNumber: | 9194898585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 29249 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8926435 | 05 | NC | MEDICAID |