Gordon Gary Koltis, M.D.

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

33390 Issued in NC

Practice address

519 Democracy PL FL 2
Apex, NC 27523-5793

Phone

(252) 916-1778

Fax

(919) 362-0717

NPI assigned

Jun 8, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Radiation Medicine, PA

  • Radiology Clinic/Center
  • Greenville, NC
  • NPI 1053315093
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768435200000",
    "number": "1508860545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 725",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275020725",
            "telephone_number": "252-916-1778",
            "fax_number": "919-362-0717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "519 DEMOCRACY PL FL 2",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275235793",
            "telephone_number": "252-916-1778",
            "fax_number": "919-362-0717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLTIS",
        "first_name": "GORDON",
        "middle_name": "GARY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "WI",
            "license": "247085",
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "PA",
            "license": "MD-035235-E",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "CA",
            "license": "G86259",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "FL",
            "license": "ME-0051462",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "NC",
            "license": "33390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "49898",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "24-00059",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9421363-001",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P00612668",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8949898",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "30013692",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa Kisicki, RN
• John Stanley Kitzmiller III, DDS
• Miles Kliewer, ATC, LAT
• Haley Klink
• Alicia Kollmar
• Kyle M Kornbau, LCMHC
• Zarna Kothari
• Vera Kotlyar, RD
• Erin Dulany Kovarik, DPT
• Sydney Kranz, LMBT

• Radiation Oncology Physician in Apex, NC
• Providers in Apex, NC by specialty
• Radiation Oncology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.