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General NPI Number Information
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NPI Number | 1457395725
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Entity Type | Organization
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Legal Business Name | RADIOLOGY FOR SOUTH PHILADELPHIA, P.C.
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 2301 S BROAD ST 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3542
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Country | US
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Telephone | 215-952-9148
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Fax | 215-952-9965
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Provider Business Mailing Address
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Address Line | 2301 S BROAD ST 2ND FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19148-3542
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Country | US
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Telephone | 215-952-9148
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Fax | 215-952-9965
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARRY CAPUTO
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Credential |
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Telephone | 215-952-9148
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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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