GORDON GARY KOLTIS M.D. NPI 1508860545

NPI Information

NPI: 1508860545
Provider Name: GORDON GARY KOLTIS, M.D.
Classification: Radiology - 2085R0001X
Entity Type: Individual

Specialization: Radiation Oncology

Address:
801 W H SMITH BLVD
GREENVILLE, NC
ZIP 27834
Phone: (252) 329-0025
Get Directions

Gordon Gary Koltis, M.D. is a radiation oncology radiology in Greenville, NC. The provider is a radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. Gordon Gary Koltis, M.D. NPI is 1508860545. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

801 W H SMITH BLVD
GREENVILLE, NC
ZIP 27834-764
Phone: (252) 329-0025
Fax: (252) 329-0325

The enumeration date for this NPI number is 6/8/2005 and was last updated on 9/10/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0001X	Radiology	Radiation Oncology	G86259	CALIFORNIA	No
2	2085R0001X	Radiology	Radiation Oncology	ME-0051462	FLORIDA	No
3	2085R0203X	Radiology	Therapeutic Radiology	MD-035235-E	PENNSYLVANIA	No
4	2085R0203X	Radiology	Therapeutic Radiology	247085	WISCONSIN	No
5	2085R0203X	Radiology	Therapeutic Radiology	MD-018789	TENNESSEE	No
6	2085R0001X	Radiology	Radiation Oncology	33390	NORTH CAROLINA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	30013692	OTHER	NORTH CAROLINA	RAILROAD MEDICARE
2	9421363-001	OTHER	NORTH CAROLINA	CIGNA
3	49898	OTHER	NORTH CAROLINA	BCBS
4	P00612668	OTHER	NORTH CAROLINA	RAILROAD MEDICARE PTAN
5	24-00059	OTHER	NORTH CAROLINA	UNITED HEALTHCARE
6	213631F	MEDICARE PIN	NORTH CAROLINA
7	8949898	MEDICAID	NORTH CAROLINA
8	E04306	MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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