MEDICARE: BYBERRY MRI & DIAGNOSTIC ASSOCIATES

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2221941000	OTHER	PA	IBC

General Provider Information

NPI Number	:	1134176944
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BYBERRY MRI & DIAGNOSTIC ASSOCIATES

Provider Business Mailing Address
First Line	:	3501 MASONS MILL RD
Second Line	:	SUITE 502
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-3517
Country	:	US
Telephone Number	:	215-659-4755
Fax Number	:	215-659-4764

Provider Business Practice Location Address
First Line	:	3501 MASONS MILL RD
Second Line	:	SUITE 502
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-3517
Country	:	US
Telephone Number	:	215-659-4755
Fax Number	:	215-659-4764

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MARIE HENNIGAR
Credential	:
Telephone Number	:	215-947-7992

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	05/19/2014

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