Provider Demographics
NPI:1518100700
Name:TOWER RADIOLOGY LLC
Entity Type:Organization
Organization Name:TOWER RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FADUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-638-4606
Mailing Address - Street 1:4255 ALTAMONT PLACE
Mailing Address - Street 2:STE 104
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695
Mailing Address - Country:US
Mailing Address - Phone:301-638-4606
Mailing Address - Fax:301-638-4608
Practice Address - Street 1:4255 ALTAMONT PLACE
Practice Address - Street 2:STE 104
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695
Practice Address - Country:US
Practice Address - Phone:301-638-4606
Practice Address - Fax:301-638-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD151531Medicare PIN