Provider Demographics
NPI:1629064548
Name:CENTRAL PENNSYLVANIA MRI CENTER
Entity Type:Organization
Organization Name:CENTRAL PENNSYLVANIA MRI CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:S
Authorized Official - Last Name:JAGANNATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-975-0445
Mailing Address - Street 1:629D LOWTHER RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBERRY
Mailing Address - State:PA
Mailing Address - Zip Code:17339-9527
Mailing Address - Country:US
Mailing Address - Phone:717-938-2765
Mailing Address - Fax:717-932-3095
Practice Address - Street 1:4665 E TRINDLE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3640
Practice Address - Country:US
Practice Address - Phone:717-975-0445
Practice Address - Fax:717-731-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANONE2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001800134Medicaid
PA480144Medicare ID - Type Unspecified