Provider Demographics
NPI:1588618540
Name:STAMFORD RADIOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:STAMFORD RADIOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-359-0130
Mailing Address - Street 1:76 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3600
Mailing Address - Country:US
Mailing Address - Phone:203-359-0130
Mailing Address - Fax:203-967-5917
Practice Address - Street 1:76 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3600
Practice Address - Country:US
Practice Address - Phone:203-359-0130
Practice Address - Fax:203-967-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00132Medicare PIN