Organization
PIEDMONT RADIATION ONCOLOGY P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLI A. REARDON (PRESIDENT)
(434) 806-0710
Entity
Organization
Contact information
Practice address
3333 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-3013
(336) 718-8592
(336) 718-9269
Mailing address
200 QUEENS RD STE 400, CHARLOTTE, NC 28204-3264
(336) 718-5095
(336) 718-9257
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011GX
NC BLUE CROSS BLUE SHIELD
NY
05
—
89011GX
—
NC
Enumeration date
10/13/2006
Last updated
02/23/2024
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