Healthcare Provider Details

I. General information

NPI: 1538152194
Provider Name (Legal Business Name): DAYTON RADIOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1479 W MAIN ST
TIPP CITY OH
45371-2803
US

IV. Provider business mailing address

1430 SPRING HILL RD SUITE 500
MC LEAN VA
22102-3000
US

V. Phone/Fax

Practice location:
  • Phone: 888-440-6494
  • Fax: 330-759-1501
Mailing address:
  • Phone: 703-287-4189
  • Fax: 703-448-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DAVID L BLOOM
Title or Position: PRESIDENT
Credential: MD
Phone: 973-707-1100