Provider Demographics
NPI:1508031253
Name:GRADY, ALLEN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:THOMAS
Last Name:GRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 85378
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5378
Mailing Address - Country:US
Mailing Address - Phone:336-274-6682
Mailing Address - Fax:336-274-8097
Practice Address - Street 1:1331 N ELM ST STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:336-274-6682
Practice Address - Fax:336-274-8097
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-010942085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology