MEDICARE: AMAR N. GULATI, PC - RAYTEL MEDICAL IMAGING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033289871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMAR N. GULATI, PC - RAYTEL MEDICAL IMAGING

Provider Business Mailing Address
First Line	:	PO BOX 548
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-0548
Country	:	US
Telephone Number	:	800-367-1095
Fax Number	:	860-298-6127

Provider Business Practice Location Address
First Line	:	3820 POWELTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5104
Country	:	US
Telephone Number	:	800-367-1095
Fax Number	:	860-298-6127

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY M FLANEGIN
Credential	:
Telephone Number	:	610-831-1112

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/30/2007

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