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General NPI Number Information
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NPI Number | 1659365021
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Entity Type | Organization
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Legal Business Name | ADVANCED IMAGING OF PORT CHARLOTTE LLC
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2625 TAMIAMI TRL UNIT 1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6478
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Country | US
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Telephone | 941-235-4646
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Fax | 941-235-4655
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Provider Business Mailing Address
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Address Line | 2625 TAMIAMI TRL UNIT 1
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6478
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Country | US
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Telephone | 941-235-4646
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Fax | 941-235-4655
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS M FABIAN
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Credential | MD
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Telephone | 941-235-4646
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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 | FL
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