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General NPI Number Information
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NPI Number | 1154320869
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Entity Type | Organization
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Legal Business Name | MOUNTAINEER RADIOLOGISTS INC
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Dates
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Enumeration Date | 07/15/2005
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1306 KANAWHA BLVD E BUILDING 2
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City | CHARLESTON
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State | WV
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Zip | 25301-3000
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Country | US
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Telephone | 304-951-1588
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1111
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City | CHARLESTON
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State | WV
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Zip | 25324-1111
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Country | US
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Telephone | 304-951-1588
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS ZEKAN
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Credential | MD
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Telephone | 304-951-1588
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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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