Provider Demographics
NPI:1417100249
Name:FULTON DIAGNOSTIC RADIOLOGY LLC
Entity Type:Organization
Organization Name:FULTON DIAGNOSTIC RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMPELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-739-6147
Mailing Address - Street 1:10715 DOWNSVILLE PIKE STE 103
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7240
Mailing Address - Country:US
Mailing Address - Phone:301-739-6144
Mailing Address - Fax:301-739-6163
Practice Address - Street 1:214 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-8559
Practice Address - Country:US
Practice Address - Phone:301-739-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DP1754OtherMEDICARE RAILROAD
PA1022427920001Medicaid
150051Medicare PIN