Healthcare Provider Details

I. General information

NPI: 1144220054
Provider Name (Legal Business Name): ANDORRA RADIOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

8305 RIDGE AVE
PHILADELPHIA PA
19128-2113
US

IV. Provider business mailing address

101 GREENWOOD AVE SUITE 150
JENKINTOWN PA
19046-2627
US

V. Phone/Fax

Practice location:
  • Phone: 215-482-4800
  • Fax: 215-482-4772
Mailing address:
  • Phone: 215-663-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL CARR
Title or Position: CFO
Credential:
Phone: 215-663-8480