Provider Demographics
NPI:1932167178
Name:ADVANCED RADIOLOGY P A
Entity type:Organization
Organization Name:ADVANCED RADIOLOGY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:I
Authorized Official - Last Name:SAFFERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-436-1215
Mailing Address - Street 1:10461 MILL RUN CIR STE 1200
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4204
Mailing Address - Country:US
Mailing Address - Phone:443-436-1116
Mailing Address - Fax:443-436-1256
Practice Address - Street 1:21 CROSSROADS DR STE 100
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5484
Practice Address - Country:US
Practice Address - Phone:888-972-9700
Practice Address - Fax:443-436-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD991125100Medicaid
MD234721100Medicaid
MDKC89ADOtherBLUE CROSS/SHIELD GROUP #