Provider Demographics
NPI:1164526497
Name:CARDENOSA, GILDA (MD)
Entity Type:Individual
Prefix:DR
First Name:GILDA
Middle Name:
Last Name:CARDENOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0470
Practice Address - Country:US
Practice Address - Phone:336-716-7243
Practice Address - Fax:336-716-7432
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012390452085R0202X
NC2000-010862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010245087 541581185Medicaid
009180M41 C03041Medicare ID - Type Unspecified
VA010245087 541581185Medicaid