Basic Information
| Provider Information | |||||||||
| NPI: | 1629292776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISENBERG | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | M.D., MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1602 PHYSICIANS DR STE 104 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104421100 | ||||||||
| FaxNumber: | 9104421199 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 INDEPENDENCE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284122482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104421100 | ||||||||
| FaxNumber: | 9104421199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 05/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 200300249 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 2021613A | 01 | NC | MEDICARE ID | OTHER | 2021613D | 01 | NC | MEDICARE PTAN | OTHER | 5907212 | 05 | NC | MEDICAID | 2021613B | 01 | NC | MEDICARE PTAN | OTHER |