Healthcare Provider Details

I. General information

NPI: 1871565994
Provider Name (Legal Business Name): PREMIER RADIOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 HOSPITAL DR
CHEVERLY MD
20785-1189
US

IV. Provider business mailing address

1201 SEVEN LOCKS RD SUITE 200
ROCKVILLE MD
20854-2931
US

V. Phone/Fax

Practice location:
  • Phone: 301-618-3340
  • Fax: 301-618-3964
Mailing address:
  • Phone: 301-652-5771
  • Fax: 301-652-6332

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: GURMEET S SIDHU
Title or Position: PRESIDENT
Credential: MD
Phone: 301-618-3340