Avalon Radiology Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

WV 17711 Issued in WV

Legal business name

AVALON RADIOLOGY INC

Practice address

202 Maplewood Ave
Radiology Department
Ronceverte, WV 24970-1334

Phone

(304) 497-2500

NPI assigned

Mar 26, 2007

Last updated

Oct 18, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Heather J Rose, MD

Title

President

Phone

(304) 497-2500

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1982722492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 MAPLEWOOD AVE",
            "address_2": "RADIOLOGY DEPARTMENT",
            "city": "RONCEVERTE",
            "state": "WV",
            "postal_code": "249701334",
            "telephone_number": "304-497-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 MAPLEWOOD AVE",
            "address_2": "RADIOLOGY DEPARTMENT",
            "city": "RONCEVERTE",
            "state": "WV",
            "postal_code": "249701334",
            "telephone_number": "304-497-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON RADIOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "ROSE",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-497-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WV",
            "license": "WV 17711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0120343000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "17711",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Ronceverte, WV
• Providers in Ronceverte, WV by specialty
• Diagnostic Radiology Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; 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.