Provider Demographics
NPI:1386704229
Name:RADIOLOGIC ASSOCIATES PC
Entity type:Organization
Organization Name:RADIOLOGIC ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-584-1320
Mailing Address - Street 1:985 FARMINGTON AVE
Mailing Address - Street 2:PO BOX 277
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3973
Mailing Address - Country:US
Mailing Address - Phone:860-584-1320
Mailing Address - Fax:860-584-2152
Practice Address - Street 1:25 COLLINS ROAD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-584-0541
Practice Address - Fax:860-584-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004000345Medicaid
CT004000345Medicaid