Provider Demographics
NPI:1013978170
Name:POTTSVILLE RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:POTTSVILLE RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELBERFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-621-5018
Mailing Address - Street 1:450 WASHINGTON ST
Mailing Address - Street 2:BOX 9
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3655
Mailing Address - Country:US
Mailing Address - Phone:570-621-5018
Mailing Address - Fax:570-621-5806
Practice Address - Street 1:420 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3625
Practice Address - Country:US
Practice Address - Phone:570-621-5325
Practice Address - Fax:570-621-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA400487Medicare ID - Type UnspecifiedMEDICARE PROVIDER #