Individual provider Active NPI

Radu Clifford Mihail, M.D.

  • Otolaryngology/Facial Plastic Surgery Physician
  • Williamsport, PA
National Provider Identifier
1730186404
Registry record updated Dec 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X
License
MD446154 Issued in PA
Practice address
1705 Warren Ave Ste 204-205
Williamsport, PA 17701-2647
Phone
(570) 320-7474
Fax
(570) 320-7479
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X 219275 NY
Otolaryngology/Facial Plastic Surgery Physician 207YX0905X MD446154 PA Primary

Addresses

Primary practice location

1705 Warren Ave Ste 204-205
Williamsport, PA 17701-2647

Mailing address

1201 Grampian Blvd
Williamsport, PA 17701-1900

Other identifiers 1

IdentifierTypeStateIssuer
02512105MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120816000172 PA Practitioner - Otolaryngology 6709860604 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Susquehanna Physician Services CurrentSince Apr 1, 2013 Accepting new patients
Susquehanna Physician Services CurrentSince Apr 1, 2013 Accepting new patients
Mid- Hudson Medical Group P C Past Accepting new patients

Locations

1705 Warren Ave
Ste 204205
Williamsport, PA 17701
Phone (570) 320-7474

700 High St
Williamsport, PA 17701
Phone (570) 321-1000

1201 Grampian Blvd
Williamsport, PA 17701
Phone (570) 326-8723

1705 Warren Ave
Ste U4
Williamsport, PA 17701
Phone (570) 320-7474

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544659200000",
    "number": "1730186404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 GRAMPIAN BLVD",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177011900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 WARREN AVE STE 204-205",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177012647",
            "telephone_number": "570-320-7474",
            "fax_number": "570-320-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIHAIL",
        "first_name": "RADU",
        "middle_name": "CLIFFORD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2018-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NY",
            "license": "219275",
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "PA",
            "license": "MD446154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02512105",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsport, PA

Sources for this page

Verify at the official NPI Registry.