Provider Demographics
NPI:1760695084
Name:RADIONCHENKO, YULIA V (MD)
Entity Type:Individual
Prefix:
First Name:YULIA
Middle Name:V
Last Name:RADIONCHENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:307 LINDSAY STREET
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4827
Practice Address - Country:US
Practice Address - Phone:333-802-2020
Practice Address - Fax:336-802-2021
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01221207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00605569OtherRAILROAD MEDICARE
NC5908335Medicaid
NC2021795Medicare PIN
NC1212660016Medicare NSC