Provider Demographics
NPI:1780722058
Name:NORTHEASTERN RADIOLOGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:NORTHEASTERN RADIOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:TK
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-774-1614
Mailing Address - Street 1:18975 VILLAVIEW RD
Mailing Address - Street 2:STE 8
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-3053
Mailing Address - Country:US
Mailing Address - Phone:216-898-1633
Mailing Address - Fax:216-267-6526
Practice Address - Street 1:200 W LORAIN ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1026
Practice Address - Country:US
Practice Address - Phone:440-775-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0773012Medicare ID - Type Unspecified