Provider Demographics
NPI:1023385440
Name:MERIDIAN RADIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MERIDIAN RADIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-620-7441
Mailing Address - Street 1:20283 STATE ROAD 7
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6901
Mailing Address - Country:US
Mailing Address - Phone:561-620-7441
Mailing Address - Fax:
Practice Address - Street 1:20283 STATE ROAD 7
Practice Address - Street 2:SUITE 400
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6901
Practice Address - Country:US
Practice Address - Phone:561-620-7441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH77152084N0400X
FLME00314792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty