Provider Demographics
NPI:1952725517
Name:NOTARGIACOMO, ALFRED (RT)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:NOTARGIACOMO
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 OLD AGENCY DR # 135A
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-7224
Mailing Address - Country:US
Mailing Address - Phone:605-742-3775
Mailing Address - Fax:
Practice Address - Street 1:603 OLD AGENCY DR # 135A
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-7224
Practice Address - Country:US
Practice Address - Phone:605-742-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF481542471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography