MEDICARE: DAYTON RADIOLOGY ASSOCIATES INC

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		OH

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	:	1538152194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYTON RADIOLOGY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1430 SPRING HILL RD
Second Line	:	SUITE 500
City	:	MC LEAN
State	:	VA
Zip	:	22102-3000
Country	:	US
Telephone Number	:	703-287-4189
Fax Number	:	703-448-1807

Provider Business Practice Location Address
First Line	:	1479 W MAIN ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-2803
Country	:	US
Telephone Number	:	888-440-6494
Fax Number	:	330-759-1501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID L BLOOM
Credential	:	MD
Telephone Number	:	973-707-1100

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	07/21/2022

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