Provider Demographics
NPI:1366647216
Name:RADIOLOGIC ASSOCIATES OF MIDDLETOWN PC
Entity Type:Organization
Organization Name:RADIOLOGIC ASSOCIATES OF MIDDLETOWN PC
Other - Org Name:INTERVENTIONAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-346-8481
Mailing Address - Street 1:57 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3606
Mailing Address - Country:US
Mailing Address - Phone:860-346-8481
Mailing Address - Fax:860-346-8836
Practice Address - Street 1:57 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-346-8481
Practice Address - Fax:860-346-8836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGIC ASSOCIATES OF MIDDLETOWN PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty