Provider Demographics
NPI:1770633224
Name:BLAIR RADIOLOGIC ASSOCIATES LTD
Entity Type:Organization
Organization Name:BLAIR RADIOLOGIC ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-696-4775
Mailing Address - Street 1:1642 OLD ROUTE 220 N
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8302
Mailing Address - Country:US
Mailing Address - Phone:814-696-4775
Mailing Address - Fax:814-687-4264
Practice Address - Street 1:1642 OLD ROUTE 220 N
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8302
Practice Address - Country:US
Practice Address - Phone:814-696-4775
Practice Address - Fax:814-687-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009303210006Medicaid
PA108722Medicare ID - Type Unspecified