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General NPI Number Information
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NPI Number | 1952724775
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Entity Type | Organization
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Legal Business Name | RADIOLOGY PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 01/30/2014
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Last Update Date | 01/31/2014
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Provider Practice Location Address
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Address Line | 18 CLARK SUMMIT DR
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City | BLUFFTON
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State | SC
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Zip | 29910-4963
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Country | US
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Telephone | 843-815-9700
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Fax | 843-815-9701
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Provider Business Mailing Address
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Address Line | 18 CLARK SUMMIT DR
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City | BLUFFTON
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State | SC
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Zip | 29910-4963
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Country | US
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Telephone | 843-815-9700
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Fax | 843-815-9701
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Authorized Official
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Title or Position | PRESIDENT & MEDICAL DIRECTOR
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Name | A JOSEPH BORELLI JR.
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Credential | MD
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Telephone | 843-815-9700
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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 | SC
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