Provider Demographics
NPI:1457336885
Name:LINK, KERRY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:MICHAEL
Last Name:LINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:LESKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC272332085B0100X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6176OtherPARTNERS
4478007OtherAETNA
NC52076OtherBCBS
NC8952076Medicaid
SCQ27233Medicaid
NC64182OtherMEDCOST
WV7230117Medicaid
WV199251000Medicaid
SCQ27233Medicaid
NC2082555DMedicare PIN
NC6176OtherPARTNERS