Organization
CHARLOTTE RADIOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE T LUTZ (MANAGER PAYER PRIVILEGING)
(704) 362-5391
Entity
Organization
Contact information
Practice address
1025 MOREHEAD MEDICAL DR STE 150, CHARLOTTE, NC 28204-2973
(704) 362-5391
Mailing address
700 E MOREHEAD ST STE 300, CHARLOTTE, NC 28202-2742
(704) 334-7800
(704) 414-7512
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5916456
—
NC
01
—
P00921619
RR MEDICARE
NC
Enumeration date
12/22/2010
Last updated
03/17/2018
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