MEDICARE: ALPHA DIAGNOSTICS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RC0000X	Cardiovascular Disease Physician
2	2084N0400X	Neurology Physician
3	2085R0204X	Vascular & Interventional Radiology Physician
4	2085U0001X	Diagnostic Ultrasound Physician
5	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1942510581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	9 GWYNNS MILL CT
Second Line	:	SUITE F
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3527
Country	:	US
Telephone Number	:	410-363-4301
Fax Number	:	410-363-4302

Provider Business Practice Location Address
First Line	:	644 FICKES SCHOOL RD
Second Line	:
City	:	YORK SPRINGS
State	:	PA
Zip	:	17372-9200
Country	:	US
Telephone Number	:	410-363-4301
Fax Number	:	410-363-4302

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	RAFAEL CHIKVASHVILI
Credential	:	PH.D
Telephone Number	:	410-363-4301

Provider Enumeration Date	:	10/18/2010
Last Update Date	:	10/18/2010

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