Provider Demographics
NPI:1851458327
Name:TRIANGLE ADVANCED DIAGNOSTIC IMAGING.
Entity Type:Organization
Organization Name:TRIANGLE ADVANCED DIAGNOSTIC IMAGING.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS,RVT
Authorized Official - Phone:919-372-1762
Mailing Address - Street 1:135 NAPERVILLE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8394
Mailing Address - Country:US
Mailing Address - Phone:919-372-1762
Mailing Address - Fax:
Practice Address - Street 1:122 WEST CHURCH STREET
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-372-1762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31412291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457420846Other1