Individual
STACY WENTWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
501 N. ELAM AVENUE, GREENSBORO, NC 27403
(336) 832-1100
Mailing address
1317 N ELM ST, STE. 1B, GREENSBORO, NC 27401-1033
(336) 274-9617
(336) 482-2177
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
2007-00580
NC
2085R0001X
Radiation Oncology Physician
Primary
200700580
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073792974
—
VA
05
—
5912234
—
NC
01
—
P00838358
MEDICARE RAILROAD
NC
Enumeration date
10/26/2007
Last updated
08/10/2012
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