Provider Demographics
NPI:1497779037
Name:LANCASTER RADIOLOGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:LANCASTER RADIOLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANGDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-286-4063
Mailing Address - Street 1:3816 LATROBE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1167
Mailing Address - Country:US
Mailing Address - Phone:704-909-5960
Mailing Address - Fax:704-770-0501
Practice Address - Street 1:800 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2202
Practice Address - Country:US
Practice Address - Phone:704-362-5391
Practice Address - Fax:704-941-3468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA3889Medicaid
NC8902104Medicaid
NC8902104Medicaid