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NPI Code Detail

MEDICARE: IMAGING GROUP OF DELAWARE, PA

MEDICARE: IMAGING GROUP OF DELAWARE, 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
12085R0204XVascular & Interventional Radiology Physician
22085R0202XDiagnostic Radiology Physician

General Provider Information

NPI Number : 1164421574
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMAGING GROUP OF DELAWARE, PA
Provider Business Mailing Address
First Line : PO BOX 784352
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19178-4352
Country : US
Telephone Number : 551-298-3605
Fax Number :
Provider Business Practice Location Address
First Line : 701 N CLAYTON ST
Second Line :
City : WILMINGTON
State : DE
Zip : 19805-3165
Country : US
Telephone Number : 302-888-2303
Fax Number :
Authorized Official
Title or Position : VICE PRESIDENT
Name : SHARLEE LEBLEU
Credential :
Telephone Number : 480-321-7026
Provider Enumeration Date : 07/18/2005
Last Update Date : 07/12/2024

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