NPIMap

Organization Active NPI

Martinsburg Radiology Assoc Inc

  • Diagnostic Radiology Physician
  • Martinsburg, WV
National Provider Identifier
1922092568
Registry record updated Mar 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MARTINSBURG RADIOLOGY ASSOC INC
Practice address
300 Foxcroft Ave
Suite 202B
Martinsburg, WV 25401-5341
Phone
(304) 263-4967
Fax
(304) 267-0974
NPI assigned
Sep 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2009

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

Authorized official

Name
Dimitri Misailidis, MD
Title
President
Phone
(304) 263-4967

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X WV Primary

Addresses

Primary practice location

300 Foxcroft Ave
Suite 202B
Martinsburg, WV 25401-5341

Mailing address

300 Foxcroft Ave
Suite 202B
Martinsburg, WV 25401-5341
Phone (304) 263-4967

Other identifiers 3

IdentifierTypeStateIssuer
001709764OtherWVMT ST BCBS
0008749000MedicaidWV
134171500MedicaidMD

National Provider Directory

National Provider Directory

Locations

295 Rock Cliff Dr
Martinsburg, WV 25401
Phone (304) 263-4967

300 Foxcroft Ave
Ste 202B
Martinsburg, WV 25401
Phone (304) 263-4967

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237939200000",
    "number": "1922092568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 FOXCROFT AVE",
            "address_2": "SUITE 202B",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254015341",
            "telephone_number": "304-263-4967",
            "fax_number": "304-267-0974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FOXCROFT AVE",
            "address_2": "SUITE 202B",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254015341",
            "telephone_number": "304-263-4967",
            "fax_number": "304-267-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTINSBURG RADIOLOGY ASSOC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-09",
        "last_updated": "2009-03-25",
        "status": "A",
        "authorized_official_last_name": "MISAILIDIS",
        "authorized_official_first_name": "DIMITRI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-263-4967",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MT ST BCBS",
            "identifier": "001709764",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008749000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134171500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.