Provider Demographics
NPI:1568497113
Name:ALPHA DIAGNOSTIC SERVICES, INC
Entity Type:Organization
Organization Name:ALPHA DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKVASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-363-4301
Mailing Address - Street 1:9 GWYNNS MILL CT
Mailing Address - Street 2:F
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3527
Mailing Address - Country:US
Mailing Address - Phone:410-363-4301
Mailing Address - Fax:410-363-4302
Practice Address - Street 1:9 GWYNNS MILL CT
Practice Address - Street 2:F
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3527
Practice Address - Country:US
Practice Address - Phone:410-363-4301
Practice Address - Fax:410-363-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000674207RC0000X, 2084N0400X, 2085R0202X, 2085R0204X, 2085U0001X, 335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52926701OtherCAREFIRST
MDMT08Medicare PIN
MDW77528Medicare UPIN
MD52926701OtherCAREFIRST
DCG00109Medicare PIN