Provider Demographics
NPI:1245236330
Name:FOX CHASE MEDICAL CENTER RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:FOX CHASE MEDICAL CENTER RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-663-5910
Mailing Address - Street 1:PO BOX 827275
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7275
Mailing Address - Country:US
Mailing Address - Phone:215-379-8458
Mailing Address - Fax:215-379-8461
Practice Address - Street 1:820 FOX CHASE RD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19046-4437
Practice Address - Country:US
Practice Address - Phone:215-663-5910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068079Medicare ID - Type Unspecified