Healthcare Provider Details

I. General information

NPI: 1467873968
Provider Name (Legal Business Name): QUANTUM IMAGING AND THERAPEUTIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 NEW LINDEN HILL RD
WILMINGTON DE
19808-2953
US

IV. Provider business mailing address

629D LOWTHER RD
LEWISBERRY PA
17339-9527
US

V. Phone/Fax

Practice location:
  • Phone: 717-932-5200
  • Fax: 717-932-3095
Mailing address:
  • Phone: 717-932-5200
  • Fax: 717-932-3095

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: ELIZABETH A BERGEY
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 717-932-5200