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NPI Code Detail

MEDICARE: PALM BEACH RADIOLOGY PROFESSIONALS, PA

MEDICARE: PALM BEACH RADIOLOGY PROFESSIONALS, 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
12085R0203XTherapeutic Radiology PhysicianME62568FL
22085R0202XDiagnostic Radiology PhysicianME62568FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396711933
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALM BEACH RADIOLOGY PROFESSIONALS, PA
Provider Business Mailing Address
First Line : DEPT AT 952288
Second Line :
City : ATLANTA
State : GA
Zip : 31192-2288
Country : US
Telephone Number : 305-503-6320
Fax Number : 305-503-6329
Provider Business Practice Location Address
First Line : 2801 N STATE ROAD 7
Second Line :
City : MARGATE
State : FL
Zip : 33063-5727
Country : US
Telephone Number : 561-548-3727
Fax Number : 561-548-1238
Authorized Official
Title or Position : DIRECTOR
Name : SANTIAGO HERNANDEZ
Credential : M.D.
Telephone Number : 561-548-3727
Provider Enumeration Date : 02/24/2006
Last Update Date : 12/30/2013

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Directions to “PALM BEACH RADIOLOGY PROFESSIONALS, PA ” Practice Location

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