Provider Demographics
NPI:1568575132
Name:CHRISTIANA NUCLEAR MEDICINE PA
Entity Type:Organization
Organization Name:CHRISTIANA NUCLEAR MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF GROUP
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-733-1525
Mailing Address - Street 1:4755 OGLETOWN STANTON ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-733-1525
Mailing Address - Fax:302-733-1818
Practice Address - Street 1:307 RUTHAR DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-8016
Practice Address - Country:US
Practice Address - Phone:302-224-5678
Practice Address - Fax:302-224-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000530902Medicaid
DE475924Medicare ID - Type Unspecified