Healthcare Provider Details

I. General information

NPI: 1073931101
Provider Name (Legal Business Name): KELSEY ROBERT BUDD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2014
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 TRENWEST DR
WINSTON SALEM NC
27103-3208
US

IV. Provider business mailing address

3010 TRENWEST DR
WINSTON SALEM NC
27103-3208
US

V. Phone/Fax

Practice location:
  • Phone: 856-924-9291
  • Fax:
Mailing address:
  • Phone: 856-924-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2017-02214
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number2017-02214
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: