Provider Demographics
NPI:1952380214
Name:IMAGING TECHNOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:IMAGING TECHNOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:KREAMER
Authorized Official - Last Name:ROOKE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:301-652-8001
Mailing Address - Street 1:486 NORRISTOWN RD
Mailing Address - Street 2:SUITE 133
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2353
Mailing Address - Country:US
Mailing Address - Phone:610-993-1640
Mailing Address - Fax:866-827-2721
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 810
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-652-8001
Practice Address - Fax:301-652-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265535Medicare PIN