MEDICARE: ATLANTIC DIAGNOSTICS LLC

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	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1740620061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	1755 N 13TH ST
Second Line	:	STE 217
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-6011
Country	:	US
Telephone Number	:	561-620-3600
Fax Number	:	404-424-9436

Provider Business Practice Location Address
First Line	:	1755 N 13TH ST
Second Line	:	STE 217
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-6011
Country	:	US
Telephone Number	:	561-620-3600
Fax Number	:	404-424-9436

Authorized Official
Title or Position	:	MANAGER
Name	:	PETER TURCO
Credential	:
Telephone Number	:	561-620-3600

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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