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General NPI Number Information
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NPI Number | 1265480446
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Entity Type | Organization
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Legal Business Name | MECKLENBURG DIAGNOSTIC IMAGING LLC
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 04/15/2013
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Provider Practice Location Address
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Address Line | 3723 UNION RD
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City | GASTONIA
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State | NC
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Zip | 28056-8044
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Country | US
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Telephone | 704-854-3933
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Fax | 704-854-3995
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Provider Business Mailing Address
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Address Line | PO BOX 933393
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City | ATLANTA
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State | GA
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Zip | 31193-0001
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Country | US
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Telephone | 866-659-1211
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Fax | 336-774-1751
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Authorized Official
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Title or Position | COO
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Name | MR. DANIEL J SCHAEFER
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Credential |
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Telephone | 770-300-0101
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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 | NC
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