Provider Demographics
NPI:1225129901
Name:RADIOLOGY & MRI OF BETHLEHEM, INC.
Entity Type:Organization
Organization Name:RADIOLOGY & MRI OF BETHLEHEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACIEJCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-691-8931
Mailing Address - Street 1:5325 NORTHGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9411
Mailing Address - Country:US
Mailing Address - Phone:610-691-8931
Mailing Address - Fax:610-691-8947
Practice Address - Street 1:5325 NORTHGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9411
Practice Address - Country:US
Practice Address - Phone:610-691-8931
Practice Address - Fax:610-691-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01128342Medicaid
PACC5242OtherPALMETTO GBA-RAILROAD
PA405224OtherHIGHMARK BLUE SHIELD
PA0054332OtherAETNA
PA02286700OtherCAPITAL BLUE CROSS
PA0054332OtherAETNA