Healthcare Provider Details

I. General information

NPI: 1295053742
Provider Name (Legal Business Name): ANTONIA B AHERN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 3RD ST
GREENSBORO NC
27405-6967
US

IV. Provider business mailing address

4309 VINSANTO WAY
SUMMERFIELD NC
27358-9560
US

V. Phone/Fax

Practice location:
  • Phone: 571-241-3701
  • Fax: 336-370-0287
Mailing address:
  • Phone: 571-241-3701
  • Fax: 336-370-0287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD042156
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2015-00792
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP25271
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: