Provider Demographics
NPI:1356420632
Name:NUCLEAR PHYICIANS LTD
Entity type:Organization
Organization Name:NUCLEAR PHYICIANS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PASSALAQUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-920-3770
Mailing Address - Street 1:4161 BRIDGEWATER PKWY
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6191
Mailing Address - Country:US
Mailing Address - Phone:330-920-3770
Mailing Address - Fax:330-920-9770
Practice Address - Street 1:4161 BRIDGEWATER PKWY
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6191
Practice Address - Country:US
Practice Address - Phone:330-920-3770
Practice Address - Fax:330-920-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0732IC261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNU9279261Medicare ID - Type Unspecified