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General NPI Number Information
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NPI Number | 1972613560
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC RADIOLOGY INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 7776 EVENING STAR LANE
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City | TALLAHASSEE
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State | FL
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Zip | 32312-3555
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Country | US
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Telephone | 850-545-1221
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Fax | 850-893-0144
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Provider Business Mailing Address
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Address Line | 7776 EVENING STAR LANE
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City | TALLAHASSEE
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State | FL
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Zip | 32312-3555
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Country | US
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Telephone | 850-893-8920
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Fax | 850-893-0144
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BELANJE SUDHAKARA HEGDE
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Credential | MD
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Telephone | 850-893-8920
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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 | 019952
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License Number State | GA
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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 | 23629
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License Number State | FL
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