Provider Demographics
NPI:1447368659
Name:TRIAD RADIOLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:TRIAD RADIOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-970-5318
Mailing Address - Street 1:3010 TRENWEST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3208
Mailing Address - Country:US
Mailing Address - Phone:336-718-5844
Mailing Address - Fax:336-970-5298
Practice Address - Street 1:3015 MAPLEWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4075
Practice Address - Country:US
Practice Address - Phone:336-794-4188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIAD RADIOLOGY ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicaid
NCPENDINGMedicaid