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General NPI Number Information
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NPI Number | 1629259262
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Entity Type | Organization
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Legal Business Name | ALPHA DIAGNOSTIC SERVICES, INC
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 2700 MARTIN LUTHER KING JR AVE SE BLDG CT8 ROOM 3
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City | WASHINGTON
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State | DC
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Zip | 20032-2601
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Country | US
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Telephone | 410-363-4301
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Fax | 410-363-4302
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Provider Business Mailing Address
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Address Line | 9 GWYNNS MILL CT SUITE F
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3527
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Country | US
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Telephone | 410-363-4301
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Fax | 410-363-4302
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | RAFAEL CHIKVASHVILI
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Credential | PHD
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Telephone | 410-363-4301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | 000674
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License Number State | MD
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