| Anthony John Atala, MD | |
|
140 Charlois Blvd, Winston Salem, NC 27103-1522 | |
| (336) 716-4131 | |
| (336) 713-0328 |
| Full Name | Anthony John Atala |
|---|---|
| Gender | Male |
| Speciality | Urology |
| Location | 140 Charlois Blvd, Winston Salem, North Carolina |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235111832 | NPI | - | NPPES |
| 891359J | Medicaid | NC | |
| 1810835000 | Medicaid | WV | |
| 1359J | Other | BCBS | |
| 10078199 | Medicaid | VA | |
| 7644683 | Other | AETNA | |
| 804009 | Other | PARTNERS | |
| D2424 | Other | MEDCOST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 200400099 (North Carolina) | Primary |
| Entity Name | Wake Forest University Health Sciences |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1003803032 PECOS PAC ID: 4486564952 Enrollment ID: O20031105000436 |
| Mailing Address | Practice Location Address |
|---|---|
| Anthony John Atala, MD 100 Kimel Forest Dr, Winston Salem, NC 27103-6074 Ph: (336) 716-0238 | Anthony John Atala, MD 140 Charlois Blvd, Winston Salem, NC 27103-1522 Ph: (336) 716-4131 |
Dr. Oliver James Hart Iii, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 2010 Baldwin Ln, Winston Salem, NC 27103 Phone: 336-277-1717 Fax: 336-277-1718 | |
Dr. Lawrence Andrew Eskew, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 3333 Silas Creek Pkwy, Winston Salem, NC 27103 Phone: 336-277-1717 Fax: 336-277-1718 | |
Steve James Hodges, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 140 Charlois Blvd, Winston Salem, NC 27103 Phone: 336-716-2255 Fax: 336-716-9042 | |
Dr. Shuo Liu, MD Urology Medicare: Medicare Enrolled Practice Location: Department Of Urology Medical Center Boulevard, Winston Salem, NC 27157 Phone: 336-716-5253 | |
Majid Mirzazadeh, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 140 Charlois Blvd, Winston Salem, NC 27103 Phone: 336-716-4131 Fax: 336-713-0328 | |
Dr. Connor Gregory Policastro, MD Urology Medicare: Medicare Enrolled Practice Location: 140 Charlois Blvd, Winston Salem, NC 27103 Phone: 336-716-4131 Fax: 336-713-0328 | |
Dr. Kyle Scarberry, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 140 Charlois Blvd, Winston Salem, NC 27103 Phone: 336-716-4131 Fax: 336-713-0328 |