Provider Demographics
NPI:1720079254
Name:MEDICAL CENTER RADIOLOGISTS INC
Entity type:Organization
Organization Name:MEDICAL CENTER RADIOLOGISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OF MED CTR RADIOLOGISTS INC
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SPECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-466-0089
Mailing Address - Street 1:PO BOX 41115
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23541-1115
Mailing Address - Country:US
Mailing Address - Phone:757-466-0089
Mailing Address - Fax:757-466-8017
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-338-3231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA165565OtherOPTIMA
VACA5826OtherRR MEDICARE
NC02126OtherBCBS
VA100042OtherSENTARA
VA139178OtherBCBS
VA1720079254Medicaid
VA165565OtherSENTARA
VA100042OtherOPTIMA
NC8902126Medicaid
VA100042OtherOPTIMA