Healthcare Provider Details

I. General information

NPI: 1497779037
Provider Name (Legal Business Name): LANCASTER RADIOLOGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MEETING ST
LANCASTER SC
29720-2202
US

IV. Provider business mailing address

3816 LATROBE DR
CHARLOTTE NC
28211-1167
US

V. Phone/Fax

Practice location:
  • Phone: 704-362-5391
  • Fax: 704-941-3468
Mailing address:
  • Phone: 704-909-5960
  • Fax: 704-770-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARK R LANGDON
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 803-286-4063