Basic Information
| Provider Information | |||||||||
| NPI: | 1851368351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADFORD | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 BLUE RIDGE ROAD | ||||||||
| Address2: | 300 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817500 | ||||||||
| FaxNumber: | 9196453440 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 BLUE RIDGE ROAD | ||||||||
| Address2: | 300 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197817500 | ||||||||
| FaxNumber: | 9196453440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 08/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 20184 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 154780 | 01 | NC | WELLPATH | OTHER | 89699 | 05 | NC | MEDICAID | 29643 | 01 | NC | MEDCOST | OTHER | 69919 | 01 | NC | BCBS | OTHER | 4481969 | 01 | NC | AETNA | OTHER | 562142486 | 01 | NC | UHC | OTHER | 1548820004 | 01 | NC | CIGNA | OTHER |