Provider Demographics
NPI:1538350855
Name:JERRY L. RADAS, P.C.
Entity type:Organization
Organization Name:JERRY L. RADAS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RADAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-490-8550
Mailing Address - Street 1:7625 MAPLE LAWN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2598
Mailing Address - Country:US
Mailing Address - Phone:301-490-8550
Mailing Address - Fax:301-490-8581
Practice Address - Street 1:7625 MAPLE LAWN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2598
Practice Address - Country:US
Practice Address - Phone:301-490-8550
Practice Address - Fax:301-490-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W3530001OtherCAREFIRST BCBS
M123JLOtherCAREFIRST BCBS OF MD
W3530001OtherCAREFIRST BCBS