Provider Demographics
NPI:1740225580
Name:CHATHAM MEDICAL RESOURCES, INC
Entity Type:Organization
Organization Name:CHATHAM MEDICAL RESOURCES, INC
Other - Org Name:TRICOUNTY MRI & DIAGNOSTIC RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-635-2000
Mailing Address - Street 1:97 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2421
Mailing Address - Country:US
Mailing Address - Phone:973-635-2000
Mailing Address - Fax:973-635-1749
Practice Address - Street 1:97 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2421
Practice Address - Country:US
Practice Address - Phone:973-635-2000
Practice Address - Fax:973-635-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3338401Medicaid
NJ3338401Medicaid