Provider Demographics
NPI:1417500034
Name:CONTRAST MEDICAL PLLC
Entity Type:Organization
Organization Name:CONTRAST MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-557-4846
Mailing Address - Street 1:813 E FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4708
Mailing Address - Country:US
Mailing Address - Phone:480-571-7713
Mailing Address - Fax:480-664-9817
Practice Address - Street 1:813 E FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4708
Practice Address - Country:US
Practice Address - Phone:480-571-7713
Practice Address - Fax:480-664-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty