Provider Demographics
NPI:1639506587
Name:CHARTER RADIOLOGY, LLC
Entity Type:Organization
Organization Name:CHARTER RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:UPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-917-2855
Mailing Address - Street 1:10 LITTLE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WEST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02576-1222
Mailing Address - Country:US
Mailing Address - Phone:800-841-5200
Mailing Address - Fax:508-273-1241
Practice Address - Street 1:10700 CHARTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3631
Practice Address - Country:US
Practice Address - Phone:443-917-2855
Practice Address - Fax:410-346-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAV43OtherCAREFIRST
MD422109500Medicaid
MD617877900OtherACS DEPT OF LABOR
MD4895107OtherAETNA- NON HMO PRODUCTS ONLY
MD329100Medicare PIN