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General NPI Number Information
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NPI Number | 1073654141
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Entity Type | Organization
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Legal Business Name | MOBILE DIAGNOSTIC SERVICES, INC.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 09/02/2013
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Provider Practice Location Address
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Address Line | 25 S OLD BALTIMORE PIKE STE 104
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City | NEWARK
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State | DE
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Zip | 19702-1540
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Country | US
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Telephone | 302-292-2700
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Fax | 302-292-2702
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Provider Business Mailing Address
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Address Line | 25 S OLD BALTIMORE PIKE STE 104
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City | NEWARK
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State | DE
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Zip | 19702-1540
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Country | US
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Telephone | 302-292-2700
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Fax | 302-292-2702
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. JOHN J GRAY III
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Credential | RDMS
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Telephone | 302-239-7700
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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 | 1990032819
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License Number State | DE
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