Organization
STANLY COUNTY IMAGING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER B GUSMER MD (PRESIDENT)
(610) 457-7964
Entity
Organization
Contact information
Practice address
301 YADKIN ST, ALBEMARLE, NC 28001-3441
(704) 984-4385
Mailing address
PO BOX 2060, ALBEMARLE, NC 28002-2060
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011RN
BCBS OF NORTH CAROLINA
NC
05
—
89011RN
—
NC
01
—
CH4185
RAILROAD MEDICARE
—
Enumeration date
06/17/2005
Last updated
02/24/2020
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