Provider Demographics
NPI:1639499239
Name:DELTA RADIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:DELTA RADIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-365-2539
Mailing Address - Street 1:PO BOX 15498
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95851-0498
Mailing Address - Country:US
Mailing Address - Phone:559-455-4053
Mailing Address - Fax:559-455-4007
Practice Address - Street 1:10200 TRINITY PKWY
Practice Address - Street 2:# 204
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7286
Practice Address - Country:US
Practice Address - Phone:209-473-3316
Practice Address - Fax:209-473-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty