Healthcare Provider Details

I. General information

NPI: 1205957370
Provider Name (Legal Business Name): YOUNGSTOWN ASSOCIATES IN RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N CANFIELD NILES RD
YOUNGSTOWN OH
44515-2328
US

IV. Provider business mailing address

7250 WEST BLVD
YOUNGSTOWN OH
44512-4346
US

V. Phone/Fax

Practice location:
  • Phone: 330-793-5547
  • Fax: 330-793-7011
Mailing address:
  • Phone: 330-758-8353
  • Fax: 330-458-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0116IC
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number0116IC
License Number StateOH

VIII. Authorized Official

Name: JUDITH MILES
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-758-8353