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General NPI Number Information
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NPI Number | 1124222328
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Entity Type | Organization
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Legal Business Name | REGIONAL RADIOLOGY LLC
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2800 ROUTE 130 N SUITE 202
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City | CINNAMINSON
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State | NJ
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Zip | 08077-3035
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Country | US
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Telephone | 856-786-7044
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Fax | 856-786-7079
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Provider Business Mailing Address
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Address Line | 2800 ROUTE 130 N SUITE 200
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City | CINNAMINSON
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State | NJ
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Zip | 08077-3035
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Country | US
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Telephone | 856-829-4555
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Fax | 856-829-6644
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Authorized Official
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Title or Position | CREDENTIALING
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Name | RENEE ANTHONY
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Credential |
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Telephone | 856-829-4555
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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 | 22772
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License Number State | NJ
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