Provider Demographics
NPI:1083973655
Name:MARU DIAGNOSTIC IMAGING SERVICES PA
Entity Type:Organization
Organization Name:MARU DIAGNOSTIC IMAGING SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-639-1674
Mailing Address - Street 1:4325 HENDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5612
Mailing Address - Country:US
Mailing Address - Phone:813-639-1674
Mailing Address - Fax:813-639-1613
Practice Address - Street 1:4325 HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5612
Practice Address - Country:US
Practice Address - Phone:813-639-1674
Practice Address - Fax:813-639-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1075802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty