Organization
VIDANT MEDICAL GROUP LLC
Active
Other names
Vidant Urology-Greenville
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CARRILEE D ANDREU-NEEL (PRACTICE ADMINISTRATOR)
(252) 816-1137
Entity
Organization
Contact information
Practice address
275 BETHESDA DR, GREENVILLE, NC 27834-7217
(252) 752-5077
(252) 752-9544
Mailing address
275 BETHESDA DR, GREENVILLE, NC 27834-7217
(252) 752-5077
(252) 752-9544
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01688
BLUE CROSS BLUE SHIELD
NC
01
—
34D0934367
CLIA ID
—
05
—
8901688
—
NC
Enumeration date
12/05/2005
Last updated
09/11/2019
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