Provider Demographics
NPI:1972589075
Name:TRISTAN ASSOCIATES
Entity Type:Organization
Organization Name:TRISTAN ASSOCIATES
Other - Org Name:SUSQUEHANNA VALLEY IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO TRISTAN ASSOCIATES
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOIA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:717-652-6105
Mailing Address - Street 1:4520 UNION DEPOSIT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2910
Mailing Address - Country:US
Mailing Address - Phone:717-652-6105
Mailing Address - Fax:717-652-2165
Practice Address - Street 1:28 SILVERMOON LN
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6354
Practice Address - Country:US
Practice Address - Phone:570-522-9300
Practice Address - Fax:570-522-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0671945Medicaid
PA0671945Medicaid