MEDICARE: MARU DIAGNOSTIC IMAGING SERVICES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME 107580	FL

General Provider Information

NPI Number	:	1083973655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARU DIAGNOSTIC IMAGING SERVICES PA

Provider Business Mailing Address
First Line	:	4325 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5612
Country	:	US
Telephone Number	:	813-639-1674
Fax Number	:	813-639-1613

Provider Business Practice Location Address
First Line	:	4325 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5612
Country	:	US
Telephone Number	:	813-639-1674
Fax Number	:	813-639-1613

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ASHLEY BRIAN MARU
Credential	:	M.D.
Telephone Number	:	813-639-1674

Provider Enumeration Date	:	05/16/2012
Last Update Date	:	05/16/2012

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