Provider Demographics
NPI:1104924463
Name:INTEGRAL NUCLEAR ASSOCIATES@BEL AIR
Entity type:Organization
Organization Name:INTEGRAL NUCLEAR ASSOCIATES@BEL AIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAY-JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-993-1640
Mailing Address - Street 1:43 LEOPARD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1552
Mailing Address - Country:US
Mailing Address - Phone:610-993-1640
Mailing Address - Fax:610-993-1640
Practice Address - Street 1:520 UPPER CHESAPEAKE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4339
Practice Address - Country:US
Practice Address - Phone:410-638-2883
Practice Address - Fax:410-638-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFMNCX4Medicare ID - Type Unspecified