Healthcare Provider Details

I. General information

NPI: 1740482686
Provider Name (Legal Business Name): FOUNDATION RADIOLOGY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 BROOKTREE CT STE 350
WEXFORD PA
15090-9271
US

IV. Provider business mailing address

PO BOX 675253
DETROIT MI
48267-5253
US

V. Phone/Fax

Practice location:
  • Phone: 412-230-8200
  • Fax: 412-230-8215
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD BLODGETT
Title or Position: PRESIDENT
Credential: MD
Phone: 412-224-6399