=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700848280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST READING RADIOLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2006
-----------------------------------------------------
Last Update Date | 02/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 S 7TH AVE STE. 135
-----------------------------------------------------
City | WEST READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19611-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-628-4580
-----------------------------------------------------
Fax | 610-736-0721
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 S 7TH AVE STE. 135
-----------------------------------------------------
City | WEST READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19611-1410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-628-4580
-----------------------------------------------------
Fax | 610-736-0721
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE COORDINATOR
-----------------------------------------------------
Name | MRS. MELISSA M. DEBOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 484-628-4580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------