Provider Demographics
NPI:1356426548
Name:PALERMO, JAMES ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANTHONY
Last Name:PALERMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 QUEENS RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3264
Mailing Address - Country:US
Mailing Address - Phone:980-890-6063
Mailing Address - Fax:
Practice Address - Street 1:2400 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1109
Practice Address - Country:US
Practice Address - Phone:336-832-1100
Practice Address - Fax:336-832-0619
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-002682085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC800249OtherPARTNERS
NC8913145Medicaid
VA5879302Medicaid
NCB8596OtherMEDCOST
NC13145OtherBCBS
NC7103448OtherAETNA
WV2005705000Medicaid
WV2005705000Medicaid
NC2006703Medicare PIN