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General NPI Number Information
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NPI Number | 1811000920
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Entity Type | Organization
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Legal Business Name | NANTICOKE RADIOLOGY, LLC
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 801 MIDDLEFORD RD
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City | SEAFORD
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State | DE
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Zip | 19973-3636
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Country | US
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Telephone | 302-629-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 10335 N PORT WASHINGTON RD 250
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City | MEQUON
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State | WI
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Zip | 53092-5763
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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 | LOUIS OWENS
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Credential | MD
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Telephone | 302-629-6611
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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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