Healthcare Provider Details

I. General information

NPI: 1629022280
Provider Name (Legal Business Name): WILLIAM G KODZAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BLUE RIDGE RD STE 100
RALEIGH NC
27612-8087
US

IV. Provider business mailing address

5220 GREENS DAIRY RD
RALEIGH NC
27616-4612
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-1437
  • Fax:
Mailing address:
  • Phone: 919-781-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number40305
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number230005-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.146197
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200400533
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101287974
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: