Provider Demographics
NPI:1881038453
Name:CARDINAL PODIATRY, P.C.
Entity Type:Organization
Organization Name:CARDINAL PODIATRY, P.C.
Other - Org Name:CARDINAL PODIATRY, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:ADAMS
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-375-6990
Mailing Address - Street 1:1852 BANKING ST # 9043
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7222
Mailing Address - Country:US
Mailing Address - Phone:336-338-7701
Mailing Address - Fax:
Practice Address - Street 1:1852 BANKING ST # 9043
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7222
Practice Address - Country:US
Practice Address - Phone:336-338-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC583213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty