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NPI Code Detail

MEDICARE: STANLY COUNTY IMAGING PLLC

MEDICARE: STANLY COUNTY IMAGING PLLC
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
12085R0202XDiagnostic Radiology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CH4185OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3011RNOTHERNCBCBS OF NORTH CAROLINA

General Provider Information

NPI Number : 1235134958
Entity Type Code : Organization
Provider Name (Legal Business Name) : STANLY COUNTY IMAGING PLLC
Provider Business Mailing Address
First Line : PO BOX 2060
Second Line :
City : ALBEMARLE
State : NC
Zip : 28002-2060
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 YADKIN ST
Second Line :
City : ALBEMARLE
State : NC
Zip : 28001-3441
Country : US
Telephone Number : 704-984-4385
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. PETER B GUSMER
Credential : MD
Telephone Number : 610-457-7964
Provider Enumeration Date : 06/17/2005
Last Update Date : 02/24/2020

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315 YADKIN ST
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1164428363 — DR. DAYNE K ROBERTS MD
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28001-3441
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1700860582 — DR. ANGELA H PEGRAM PHARMD, CDE
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Practice Fax: 704-983-7846

Directions to “STANLY COUNTY IMAGING PLLC ” Practice Location

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