Provider Demographics
NPI:1215996236
Name:MITRO, GREGORY C (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:MITRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 QUEENS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3252
Mailing Address - Country:US
Mailing Address - Phone:704-333-7376
Mailing Address - Fax:704-333-3397
Practice Address - Street 1:229 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3325
Practice Address - Country:US
Practice Address - Phone:704-797-8820
Practice Address - Fax:704-210-6877
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2000005502085R0001X
SC226092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
44131OtherPARTNERS
A7859OtherMEDCOST
2145532OtherUNITED HEALTHCARE
NC891254XMedicaid
SCN00554Medicaid
NC1254XOtherBLUE CROSS
9354064004OtherCIGNA
920006191Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NC891254XMedicaid
NC2280774EMedicare ID - Type UnspecifiedLAKE NORMAN RAD ONC CTR
9354064004OtherCIGNA
SCH127226058Medicare ID - Type UnspecifiedSC MEDICARE
NCH12722Medicare UPIN
NC2280074CMedicare ID - Type UnspecifiedMATTHEWS RAD ONC CTR