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General NPI Number Information
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NPI Number | 1053570747
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Entity Type | Organization
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Legal Business Name | WADSWORTH IMAGING, INC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 195 WADSWORTH RD
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City | WADSWORTH
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State | OH
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Zip | 44281-9504
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Country | US
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Telephone | 330-334-1504
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Fax |
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Provider Business Mailing Address
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Address Line | 3090 W MARKET ST SUITE 102
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City | FAIRLAWN
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State | OH
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Zip | 44333-3608
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Country | US
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Telephone | 330-864-7109
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Fax | 330-869-8910
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NORMAN L CROCKER
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Credential | MD
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Telephone | 330-864-7109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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