MEDICARE: IMAGING PROFESSIONALS OF PENNSYLVANIA PC

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		PA

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	:	1952394363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGING PROFESSIONALS OF PENNSYLVANIA PC

Provider Business Mailing Address
First Line	:	PO BOX 827275
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-7275
Country	:	US
Telephone Number	:	215-663-5910
Fax Number	:	215-663-2451

Provider Business Practice Location Address
First Line	:	301 CALLOWHILL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-4103
Country	:	US
Telephone Number	:	215-574-9400
Fax Number	:	215-574-1563

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKE CARR
Credential	:
Telephone Number	:	215-663-5910

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/21/2022

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