Healthcare Provider Details

I. General information

NPI: 1972861722
Provider Name (Legal Business Name): TELERAD OF CT ACCOUNT MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 HOFFMANN RD
CANTON CT
06019-2123
US

IV. Provider business mailing address

13737 NOEL RD SUITE 1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 973-251-1132
  • Fax: 214-712-2487
Mailing address:
  • Phone: 954-838-2371
  • Fax: 214-712-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN KONDAS
Title or Position: OFFICER
Credential:
Phone: 973-251-1132