=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073568309
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BTD RADIOLOGY AT SALEM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 09/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 WOODSTOWN RD
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-339-6054
-----------------------------------------------------
Fax | 856-935-4970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11028
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-293-3223
-----------------------------------------------------
Fax | 717-390-2455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KEVIN J BYRNE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 856-339-6054
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085B0100X
-----------------------------------------------------
Taxonomy Name | Body Imaging Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------