MEDICARE: DR. KELSEY ROBERT BUDD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2085R0202X	Diagnostic Radiology Physician	2017-02214	NC

General Provider Information

NPI Number	:	1073931101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSEY ROBERT BUDD M.D.

Provider Business Mailing Address
First Line	:	604 CRAIG ST
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-1907
Country	:	US
Telephone Number	:	856-924-9291
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 OLD CLINIC CB# 7510
Second Line	:	RADIOLOGY CHAIRMAN'S OFFICE
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599
Country	:	US
Telephone Number	:	856-924-9291
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2014
Last Update Date	:	12/31/2019

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