Provider Demographics
NPI:1295045839
Name:ALPHA DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:ALPHA DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKVASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-363-4301
Mailing Address - Street 1:9 GWYNNS MILL CT
Mailing Address - Street 2:SUITE F
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3527
Mailing Address - Country:US
Mailing Address - Phone:410-363-4301
Mailing Address - Fax:410-363-4302
Practice Address - Street 1:9 GWYNNS MILL CT
Practice Address - Street 2:SUITE F
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3527
Practice Address - Country:US
Practice Address - Phone:410-363-4301
Practice Address - Fax:410-363-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier