Organization
SOUTHEASTERN HEART & VASCULAR CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN J BERRY MD (EXECUTIVE DIRECTOR)
(336) 273-7900
Entity
Organization
Contact information
Practice address
3200 NORTHLINE AVE, SUITE 250, GREENSBORO, NC 27408-7619
(336) 273-7900
(336) 273-8147
Mailing address
3200 NORTHLINE AVE, SUITE 250, GREENSBORO, NC 27408-7616
(336) 273-7900
(336) 273-8147
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0129F
BCBS NC
NC
05
—
790129F
—
NC
Enumeration date
09/20/2006
Last updated
01/18/2013
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