Healthcare Provider Details

I. General information

NPI: 1992839518
Provider Name (Legal Business Name): MED TEL INTERNATIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PHOENIX DR UNIT A
CHAMBERSBURG PA
17201-4534
US

IV. Provider business mailing address

1430 SPRING HILL RD SUITE 500
MCLEAN VA
22102-3000
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-4999
  • Fax: 717-263-5522
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 Number20-48857
License Number StatePA

VIII. Authorized Official

Name: JOHN VALLA
Title or Position: VICE PRESIDENT
Credential:
Phone: 973-873-9850