Healthcare Provider Details

I. General information

NPI: 1134176092
Provider Name (Legal Business Name): MARIETTA IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

PO BOX 182255
COLUMBUS OH
43218-2255
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-1410
  • Fax: 740-374-1691
Mailing address:
  • Phone: 614-430-5729
  • Fax:

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: WILLIAM C GROSEL
Title or Position: PRESIDENT
Credential: MD
Phone: 740-374-1410