Provider Demographics
NPI:1770534307
Name:SUFFOLK RADIOLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:SUFFOLK RADIOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CANADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-262-6900
Mailing Address - Street 1:PO BOX 15539
Mailing Address - Street 2:SUFFOLK RADIOLOGY ASSOCIATES
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-5539
Mailing Address - Country:US
Mailing Address - Phone:757-366-0101
Mailing Address - Fax:757-366-8792
Practice Address - Street 1:2800 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8038
Practice Address - Country:US
Practice Address - Phone:757-366-0101
Practice Address - Fax:757-366-8792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACA1602OtherRAILROAD MEDICARE
VACA1602OtherRAILROAD MEDICARE