Healthcare Provider Details

I. General information

NPI: 1114076510
Provider Name (Legal Business Name): HARRISON RADIOLOGY ASSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 E MARKET ST
CADIZ OH
43907-9799
US

IV. Provider business mailing address

PO BOX 6490
ERIE PA
16512-6490
US

V. Phone/Fax

Practice location:
  • Phone: 740-922-7450
  • Fax:
Mailing address:
  • Phone: 814-480-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. SANJAY SHAH
Title or Position: OWNER
Credential: M.D.
Phone: 740-922-7450