Provider Demographics
NPI:1679579775
Name:DELAWARE OPEN MRI RADIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:DELAWARE OPEN MRI RADIOLOGY ASSOCIATES LLC
Other - Org Name:AKUMIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-515-0362
Mailing Address - Street 1:101 GREENWOOD AVENUE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-663-5910
Mailing Address - Fax:215-663-2451
Practice Address - Street 1:H 42 OMEGA DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-738-1700
Practice Address - Fax:302-738-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000900602Medicaid
DEG00145Medicare PIN