Provider Demographics
NPI:1811996960
Name:RADIOLOGICAL PHYSICIAN ASSOCIATES INC
Entity type:Organization
Organization Name:RADIOLOGICAL PHYSICIAN ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-624-2121
Mailing Address - Street 1:PO BOX 890707
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0707
Mailing Address - Country:US
Mailing Address - Phone:866-338-6463
Mailing Address - Fax:
Practice Address - Street 1:700 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-7985
Practice Address - Country:US
Practice Address - Phone:304-366-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0010747000Medicaid
WV1041208OtherWORKERS COMP
WV9292641Medicare PIN