Healthcare Provider Details

I. General information

NPI: 1811996960
Provider Name (Legal Business Name): RADIOLOGICAL PHYSICIAN ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 VILLAGE DR
FAIRMONT WV
26554-7985
US

IV. Provider business mailing address

PO BOX 890707
CHARLOTTE NC
28289-0707
US

V. Phone/Fax

Practice location:
  • Phone: 304-366-2600
  • Fax:
Mailing address:
  • Phone: 866-338-6463
  • Fax:

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: JOHN A LEON
Title or Position: PRESIDENT
Credential: MD
Phone: 304-624-2121