1699733527 NPI number — DELMARVA RADIOLOGY P.A.

Table of content: (NPI 1699733527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699733527 NPI number — DELMARVA RADIOLOGY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELMARVA RADIOLOGY P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699733527
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
918 EASTERN SHORE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21804-6410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-1124
Provider Business Mailing Address Fax Number:
410-749-1270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E CARROLL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALISBURY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21801-5422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-543-7356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZITO
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-749-1124

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085N0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1102028 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016993600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".