Provider Demographics
NPI:1093981300
Name:RALSTON, EMILIE CAMILLE (MD)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:CAMILLE
Last Name:RALSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILIE
Other - Middle Name:CAMILLE
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1987
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1987
Mailing Address - Country:US
Mailing Address - Phone:828-213-0594
Mailing Address - Fax:828-213-0590
Practice Address - Street 1:534 BILTMORE AVE
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4612
Practice Address - Country:US
Practice Address - Phone:828-213-0800
Practice Address - Fax:828-213-0804
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-013122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093981300Medicaid
SCQ12009Medicaid
WV3810023699Medicaid
NC5920568Medicaid
SCQ12009Medicaid