Provider Demographics
NPI:1679519706
Name:AHLBERG, DAVID JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:AHLBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12459
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-2459
Mailing Address - Country:US
Mailing Address - Phone:910-939-0724
Mailing Address - Fax:910-333-9145
Practice Address - Street 1:39 OFFICE PARK DR STE A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3220
Practice Address - Country:US
Practice Address - Phone:910-939-0724
Practice Address - Fax:910-333-9145
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005001472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902871Medicaid