Healthcare Provider Details

I. General information

NPI: 1881038453
Provider Name (Legal Business Name): CARDINAL PODIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1852 BANKING ST # 9043
GREENSBORO NC
27408-7222
US

IV. Provider business mailing address

1852 BANKING ST # 9043
GREENSBORO NC
27408-7222
US

V. Phone/Fax

Practice location:
  • Phone: 336-338-7701
  • Fax:
Mailing address:
  • Phone: 336-338-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number583
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number583
License Number StateNC

VIII. Authorized Official

Name: DR. ALISON ADAMS DURHAM
Title or Position: SHAREHOLDER
Credential: DPM
Phone: 336-375-6990