Healthcare Provider Details

I. General information

NPI: 1417956079
Provider Name (Legal Business Name): NAZARETH IMAGING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 HOLME AVE
PHILADELPHIA PA
19152-2007
US

IV. Provider business mailing address

PO BOX 892
CONCORDVILLE PA
19331-0892
US

V. Phone/Fax

Practice location:
  • Phone: 215-335-7785
  • Fax:
Mailing address:
  • Phone: 215-335-7785
  • 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: DR. DONALD OSTRUM
Title or Position: HEAD RADIOLOGIST
Credential: M.D.
Phone: 215-335-7785