MEDICARE: DIAGNOSTIC RADIOLOGY & IMAGING, LLC

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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992736326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC RADIOLOGY & IMAGING, LLC

Provider Business Mailing Address
First Line	:	1331 NORTH ELM STREET
Second Line	:	SUITE 200
City	:	GREENSBORO
State	:	NC
Zip	:	27401-6304
Country	:	US
Telephone Number	:	336-274-4285
Fax Number	:	336-482-2177

Provider Business Practice Location Address
First Line	:	315 W WENDOVER AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-8401
Country	:	US
Telephone Number	:	336-433-5000
Fax Number	:	336-433-5103

Authorized Official
Title or Position	:	AVP REGIONAL OPERATIONS
Name	:	CHRISTIAN SCOTT WILSON
Credential	:
Telephone Number	:	336-540-4322

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/30/2021

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