Fulton Diagnostic Radiology LLC
Organization Active NPI Diagnostic Radiology Physician · MC Connellsburg, PA
NPI 1417100249 · NPPES record last updated Apr 27, 2020
Key facts
- NPI
- 1417100249
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- FULTON DIAGNOSTIC RADIOLOGY LLC
- Practice address
- 214 Peach Orchard Rd
MC Connellsburg, PA 17233-8559 - Phone
- (301) 739-6144
- NPI assigned
- Oct 24, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Zampelli
- Title
- Coo
- Phone
- (301) 739-6147
Member of 1
Practitioners 18
-
Zakaria Aqel, M.D.
-
Oliver Chen, M.D.
-
Nina J. Gordon, M.D.
-
Shane Keogh, MD
-
Taik-Kun Kim, M.D.
-
Robert Lee, M.D.
-
Paul C Marinelli, M.D.
-
Robert E Mazzei, D.O.
-
Narasim S Murthy, M.D.
-
Joshua Martin Similuk, D.O.
-
Gregory S Zimmermann, M.D.
-
Mansoor A Husain, MD
-
Mubeen A Khan, M.D.
-
Kevin Francis McCarthy, M.D.
-
Saudur Rahman, M.D.
-
Trung Q Vu, M.D.
-
Alex Mark Wurm, M.D.
-
Lisa Ona Ballehr, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in PA, AZ, IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090504000327 | PA | Part B Supplier - Clinic/Group Practice | 5991853806 |
Receives reassigned benefits from 16 practitioners Practice locations: MC Connellsburg, PA |
| O20200424001902 | AZ | Part B Supplier - Clinic/Group Practice | 5991853806 |
Receives reassigned benefits from 1 practitioner Practice locations: Mesa, AZ |
| O20210325001609 | IL | Part B Supplier - Clinic/Group Practice | 5991853806 |
Receives reassigned benefits from 1 practitioner Practice locations: Libertyville, IL |
National Provider Directory
Locations
10715 Downsville Pike
Ste 103
Hagerstown, MD 21740
Phone (240) 313-9940
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes |
Addresses
Primary practice location
214 Peach Orchard Rd
MC Connellsburg, PA 17233-8559
Mailing address
10715 Downsville Pike Ste 103
Hagerstown, MD 21740-7240
Phone (301) 739-6144
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DP1754 | Other | MEDICARE RAILROAD | |
| 1022427920001 | Medicaid | PA |
Other providers in MC Connellsburg, PA
- Fulton County Medical Center
- Fulton County Medical Center
- Fulton County Medical Center
- Fulton County Medical Center
- Fulton County Partnership
- Fulton Diagnostic Radiology, LLC
- Gaudenzia
- Erin Camille Glenn
- Elizabeth T. Gotwals
- Cody Grace
All providers in MC Connellsburg, PA · Diagnostic Radiology Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.