Provider Demographics
NPI: | 1497297337 |
---|---|
Name: | ONSITE RADIOLOGIST |
Entity Type: | Organization |
Organization Name: | ONSITE RADIOLOGIST |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MUNIRA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CHARANIA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 312-929-8662 |
Mailing Address - Street 1: | 1003 QUAKER RIDGE WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | DULUTH |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30097-2049 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 312-929-8662 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3547 PEACHTREE INDUSTRIAL BLVD |
Practice Address - Street 2: | |
Practice Address - City: | DULUTH |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30096-1419 |
Practice Address - Country: | US |
Practice Address - Phone: | 312-929-8662 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-11-09 |
Last Update Date: | 2016-11-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 2085B0100X | |
2085B0100X, 2085D0003X, 2085H0002X, 2085N0700X, 2085P0229X, 2085R0202X, 2085R0203X, 2085R0204X, 2085R0205X, 2085U0001X, 247100000X, 2471B0102X, 2471C3401X, 2471M1202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
No | 2085D0003X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | Group - Multi-Specialty |
No | 2085H0002X | Allopathic & Osteopathic Physicians | Radiology | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | Group - Multi-Specialty |
No | 2085P0229X | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | Group - Multi-Specialty |
No | 2085R0203X | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | Group - Multi-Specialty |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
No | 2085R0205X | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | Group - Multi-Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
No | 247100000X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Group - Multi-Specialty | |
No | 2471B0102X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Bone Densitometry | Group - Multi-Specialty |
No | 2471C3401X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography | Group - Multi-Specialty |
No | 2471M1202X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Magnetic Resonance Imaging | Group - Multi-Specialty |