Provider Demographics
NPI:1740464643
Name:AUBURN RADIOLOGY PC
Entity type:Organization
Organization Name:AUBURN RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-782-2620
Mailing Address - Street 1:1116 ARSENAL ST STE 504
Mailing Address - Street 2:PO BOX 6120
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2229
Mailing Address - Country:US
Mailing Address - Phone:315-782-2620
Mailing Address - Fax:315-788-4980
Practice Address - Street 1:17 LANSING ST
Practice Address - Street 2:AUBURN MEMORIAL HOSPITAL
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021
Practice Address - Country:US
Practice Address - Phone:315-782-2620
Practice Address - Fax:315-788-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN