Provider Demographics
NPI:1114126489
Name:EAST COAST IMAGING ASSOC PA
Entity Type:Organization
Organization Name:EAST COAST IMAGING ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-270-2108
Mailing Address - Street 1:301 WIDGEON DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-2436
Mailing Address - Country:US
Mailing Address - Phone:910-270-2108
Mailing Address - Fax:
Practice Address - Street 1:301 WIDGEON DR
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-2436
Practice Address - Country:US
Practice Address - Phone:910-270-2108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC322362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC230708Medicare PIN
VA016042C19Medicare PIN