MEDICARE: RADIOLOGY ASSOCIATES PA OF FORT LAUDERDALE

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659323632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY ASSOCIATES PA OF FORT LAUDERDALE

Provider Business Mailing Address
First Line	:	PO BOX 93
Second Line	:
City	:	LANDISVILLE
State	:	PA
Zip	:	17538-0093
Country	:	US
Telephone Number	:	800-800-1617
Fax Number	:	866-759-5426

Provider Business Practice Location Address
First Line	:	7201 N UNIVERSITY DR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-2913
Country	:	US
Telephone Number	:	954-721-2200
Fax Number	:

Authorized Official
Title or Position	:	PRES
Name	:	DR. GASTON MENDEZ JR.
Credential	:	MD
Telephone Number	:	954-721-2200

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/01/2013

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