Provider Demographics
NPI:1356508386
Name:ORTHOPAEDIC & NEURO IMAGING LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC & NEURO IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PFARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-628-7655
Mailing Address - Street 1:1350 MIDDLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3664
Mailing Address - Country:US
Mailing Address - Phone:302-628-7655
Mailing Address - Fax:
Practice Address - Street 1:1350 MIDDLEFORD RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3664
Practice Address - Country:US
Practice Address - Phone:302-628-7655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG556OtherBLUE SHIELD
MDKEU8OROtherBLUE SHIELD
DE1000016103Medicaid
DE=========OtherBLUE SHIELD