1952380214 NPI number — IMAGING TECHNOLOGY ASSOCIATES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952380214 NPI number — IMAGING TECHNOLOGY ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGING TECHNOLOGY ASSOCIATES LLC
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:
1952380214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
486 NORRISTOWN RD
Provider Second Line Business Mailing Address:
SUITE 133
Provider Business Mailing Address City Name:
BLUE BELL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19422-2353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-993-1640
Provider Business Mailing Address Fax Number:
866-827-2721

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5454 WISCONSIN AVE
Provider Second Line Business Practice Location Address:
SUITE 810
Provider Business Practice Location Address City Name:
CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-6901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-652-8001
Provider Business Practice Location Address Fax Number:
301-652-8002
Provider Enumeration Date:
01/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROOKE
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
KREAMER
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
301-652-8001

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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