Provider Demographics
NPI:1194902650
Name:MONTGOMERY RADIOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:MONTGOMERY RADIOLOGY ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-337-5991
Mailing Address - Street 1:20 EXPEDITION TRL
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8598
Mailing Address - Country:US
Mailing Address - Phone:717-337-5991
Mailing Address - Fax:717-337-5995
Practice Address - Street 1:20 EXPEDITION TRL
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-8598
Practice Address - Country:US
Practice Address - Phone:717-337-5991
Practice Address - Fax:717-337-5995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY RADIOLOGY ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018049660023Medicaid
PA0018049660023Medicaid