Provider Demographics
NPI:1194770537
Name:KINSTON RADIOLOGICAL ASSOC., PA
Entity type:Organization
Organization Name:KINSTON RADIOLOGICAL ASSOC., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-527-7077
Mailing Address - Street 1:701 DOCTORS DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1584
Mailing Address - Country:US
Mailing Address - Phone:252-527-7077
Mailing Address - Fax:252-527-0565
Practice Address - Street 1:701 DOCTORS DR
Practice Address - Street 2:SUITE M
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1584
Practice Address - Country:US
Practice Address - Phone:252-527-7077
Practice Address - Fax:252-527-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC333382085R0202X
NC97014412085R0202X
NC98005662085R0202X
NC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901970Medicaid
NC8901970Medicaid