Provider Demographics
NPI:1902837404
Name:FORSYTH RADILOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:FORSYTH RADILOGICAL ASSOCIATES
Other - Org Name:MAPLEWOOD IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKARZYNKSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-794-4372
Mailing Address - Street 1:3155 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3903
Mailing Address - Country:US
Mailing Address - Phone:336-794-4372
Mailing Address - Fax:336-659-2379
Practice Address - Street 1:3155 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3903
Practice Address - Country:US
Practice Address - Phone:336-794-4372
Practice Address - Fax:336-659-2379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901527Medicaid
NC8901527Medicaid