Basic Information
| Provider Information | |||||||||
| NPI: | 1093981300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RALSTON | ||||||||
| FirstName: | EMILIE | ||||||||
| MiddleName: | CAMILLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRADY | ||||||||
| OtherFirstName: | EMILIE | ||||||||
| OtherMiddleName: | CAMILLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1987 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462061987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282130594 | ||||||||
| FaxNumber: | 8282130590 | ||||||||
| Practice Location | |||||||||
| Address1: | 534 BILTMORE AVE | ||||||||
| Address2: | RADIOLOGY DEPT | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282130800 | ||||||||
| FaxNumber: | 8282130804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2008 | ||||||||
| LastUpdateDate: | 02/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 2009-01312 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1093981300 | 05 | VA | MEDICAID | Q12009 | 05 | SC | MEDICAID | 3810023699 | 05 | WV | MEDICAID | 5920568 | 05 | NC | MEDICAID |