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General NPI Number Information
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NPI Number | 1689777245
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Entity Type | Organization
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Legal Business Name | MID CAROLINA RADIOLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 1135 CARTHAGE ST
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City | SANFORD
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State | NC
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Zip | 27330-4162
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Country | US
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Telephone | 919-777-7092
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Fax | 775-624-9774
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Provider Business Mailing Address
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Address Line | PO BOX 63367
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City | CHARLOTTE
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State | NC
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Zip | 28263-3367
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Country | US
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Telephone | 844-825-9300
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Fax | 775-624-9774
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN W WITTENBORN
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Credential | MD
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Telephone | 919-774-2055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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