NPIMap

Individual provider Active NPI

Atif Nasrullah

  • Internal Medicine Physician
  • Edenton, NC
National Provider Identifier
1710656558
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
2025-00687 Issued in NC
Practice address
104 Mark Dr
Edenton, NC 27932-1756
Phone
(252) 482-5171
NPI assigned
Sep 7, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X MT224569 PA
Internal Medicine Physician 207R00000X 2025-00687 NC Primary

Addresses

Primary practice location

104 Mark Dr
Edenton, NC 27932-1756

Mailing address

104 Mark Dr
Edenton, NC 27932-1756
Phone (252) 482-5171

Other practice location 1

501 S Washington Ave, The Wright Center
Scranton, PA 18505
Phone (570) 507-3027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250917000482 NC Practitioner - Internal Medicine 1557735909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

104 Mark Dr
Edenton, NC 27932-1756
Phone (252) 482-5171

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2025-00687NCMDInternal Medicine Physician
MT224569PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
The Wright Center Medical Group Internal Medicine CurrentSince Feb 24, 2022 Accepting new patients
Vidant Medical Group LLC CurrentSince Aug 25, 2025 Accepting new patients

Locations

104 Mark Dr
Edenton, NC 27932
Phone (252) 482-5171

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

501 S Washington Ave
Scranton, PA 18505
Phone (570) 591-5153

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1710656558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MARK DR",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321756",
            "telephone_number": "252-482-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MARK DR",
            "city": "EDENTON",
            "state": "NC",
            "postal_code": "279321756",
            "telephone_number": "252-482-5171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 S Washington Ave, The Wright Center",
            "address_purpose": "LOCATION",
            "city": "Scranton",
            "state": "PA",
            "postal_code": "18505",
            "country_code": "US",
            "telephone_number": "570-507-3027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NASRULLAH",
        "first_name": "ATIF",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-07",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT224569",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2025-00687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edenton, NC

Sources for this page

Verify at the official NPI Registry.