Provider Demographics
NPI:1265457931
Name:ROCHESTER RADIOLOGY PC
Entity Type:Organization
Organization Name:ROCHESTER RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOREDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-652-5617
Mailing Address - Street 1:1101 W UNIVERSITY DR
Mailing Address - Street 2:RADIOLOGY DEPT
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1831
Mailing Address - Country:US
Mailing Address - Phone:248-652-5325
Mailing Address - Fax:248-652-9731
Practice Address - Street 1:1101 W UNIVERSITY DR
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1831
Practice Address - Country:US
Practice Address - Phone:248-652-5325
Practice Address - Fax:248-652-9731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F36447Medicare ID - Type Unspecified