Healthcare Provider Details

I. General information

NPI: 1215106182
Provider Name (Legal Business Name): ALPHA DIAGNOSTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FARMSTEAD CT SUITE B
HOCKESSIN DE
19707-2335
US

IV. Provider business mailing address

9 GWYNNS MILL CT SUITE F
OWINGS MILLS MD
21117-3527
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-4301
  • Fax: 410-363-4302
Mailing address:
  • Phone: 410-363-4301
  • Fax: 410-363-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number2006601706
License Number StateDE

VIII. Authorized Official

Name: RAFAEL CHIKVASHVILI
Title or Position: PRESIDENT-CEO
Credential: PH.D
Phone: 410-363-4301