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NPI Code Detail

MEDICARE: DR. JEFFREY JOHN RALSTON DO

MEDICARE: DR. JEFFREY JOHN RALSTON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician200400578NC
2207U00000XNuclear Medicine Physician2004-00578NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275538449
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY JOHN RALSTON DO
Provider Business Mailing Address
First Line : PO BOX 221249
Second Line :
City : CHARLOTTE
State : NC
Zip : 28222-1249
Country : US
Telephone Number : 704-332-1291
Fax Number : 704-332-5206
Provider Business Practice Location Address
First Line : 3623 LATROBE DR STE 216
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-2117
Country : US
Telephone Number : 704-332-1291
Fax Number : 704-926-1832
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 09/13/2020

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Directions to “ DR. JEFFREY JOHN RALSTON DO” Practice Location

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