Provider Demographics
NPI:1255379343
Name:RIVERDALE RADIOLOGY, LLC
Entity type:Organization
Organization Name:RIVERDALE RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HARSANYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-277-1890
Mailing Address - Street 1:6504 KENILWORTH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1386
Mailing Address - Country:US
Mailing Address - Phone:301-277-1890
Mailing Address - Fax:301-927-8468
Practice Address - Street 1:6504 KENILWORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1386
Practice Address - Country:US
Practice Address - Phone:301-277-1890
Practice Address - Fax:301-927-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
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
MDG01488Medicare ID - Type Unspecified