Provider Demographics
NPI:1639152325
Name:WILEY, ALBERT L JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:L
Last Name:WILEY
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:LEO JENKINS CANCER CENTER
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-744-2900
Practice Address - Fax:252-744-3844
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC203632085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900477Medicaid
NC87389OtherBCBS NC
NC5900477Medicaid
NC87389OtherBCBS NC