Healthcare Provider Details

I. General information

NPI: 1194233247
Provider Name (Legal Business Name): TRI STATE MRI & IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 COLLEGE RD STE 105
DOVER DE
19904-6506
US

IV. Provider business mailing address

14 AZALEA RD
NEWARK DE
19711-6812
US

V. Phone/Fax

Practice location:
  • Phone: 302-513-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: TROY MOFFITT-ALI
Title or Position: OWNER
Credential:
Phone: 302-513-4500