Provider Demographics
NPI:1134353477
Name:SHORELINE RADIOLOGY PLLC
Entity type:Organization
Organization Name:SHORELINE RADIOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORANGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-374-7288
Mailing Address - Street 1:10567 SAWMILL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-6672
Mailing Address - Country:US
Mailing Address - Phone:614-210-1885
Mailing Address - Fax:
Practice Address - Street 1:10567 SAWMILL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-6672
Practice Address - Country:US
Practice Address - Phone:614-210-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS177252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty