Provider Demographics
NPI:1841279718
Name:SUMMERS, HELENA G (MD)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:G
Last Name:SUMMERS
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 1:3010 TRENWEST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3208
Mailing Address - Country:US
Mailing Address - Phone:336-970-5300
Mailing Address - Fax:336-970-5298
Practice Address - Street 1:3010 TRENWEST DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3208
Practice Address - Country:US
Practice Address - Phone:336-718-5844
Practice Address - Fax:336-970-5298
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN480612085R0202X
NC2009014942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00771180OtherMEDICARE, RAILROAD
NC5913913Medicaid
MNENROLLEDMedicaid
NC2076476Medicare PIN
MN300005382Medicare PIN
I47458Medicare UPIN
NC5913913Medicaid
MNENROLLEDMedicaid