Healthcare Provider Details

I. General information

NPI: 1568497113
Provider Name (Legal Business Name): ALPHA DIAGNOSTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

9 GWYNNS MILL CT 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 TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number000674
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number000674
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number000674
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number000674
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number000674
License Number StateMD
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number000674
License Number StateMD

VIII. Authorized Official

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