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General NPI Number Information
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NPI Number | 1740482686
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Entity Type | Organization
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Legal Business Name | FOUNDATION RADIOLOGY GROUP PC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 6400 BROOKTREE CT STE 350
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City | WEXFORD
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State | PA
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Zip | 15090-9271
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Country | US
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Telephone | 412-230-8200
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Fax | 412-230-8215
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Provider Business Mailing Address
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Address Line | PO BOX 675253
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City | DETROIT
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State | MI
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Zip | 48267-5253
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TODD BLODGETT
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Credential | MD
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Telephone | 412-224-6399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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