Provider Demographics
NPI:1972980704
Name:PENNSYLVANIA RADIOLOGY GROUP
Entity Type:Organization
Organization Name:PENNSYLVANIA RADIOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHEEP
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-246-7168
Mailing Address - Street 1:43 W RIDGE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1711
Mailing Address - Country:US
Mailing Address - Phone:610-226-6208
Mailing Address - Fax:610-226-6208
Practice Address - Street 1:43 W RIDGE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1711
Practice Address - Country:US
Practice Address - Phone:610-226-6208
Practice Address - Fax:610-226-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046031L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty