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General NPI Number Information
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NPI Number | 1154450351
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Entity Type | Organization
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Legal Business Name | ADVANCE TECHNOLOGICAL RADIOLOGY, PA
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 2235 NORTH BOULEVARD WEST
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City | DAVENPORT
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State | FL
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Zip | 33837-8990
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Country | US
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Telephone | 863-421-9393
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Fax | 866-560-1517
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Provider Business Mailing Address
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Address Line | P.O. BOX 2159
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City | HAINES CITY
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State | FL
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Zip | 33845-2159
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Country | US
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Telephone | 863-421-9393
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Fax | 866-560-1517
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY T ROSA
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Credential | MD
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Telephone | 863-421-9393
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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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