Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Mar 31, 2011
License(s)
D88844 (MD), 4301508236 (MI), MD455929 (PA), TMD005113 (PA), TMD005113 (PA), 278867 (MA), 278867 (MA), D88844 (MD)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 14 HEATHROW CT | Marlboro, NJ 07746-2707 | 732-974-0003 |
| LOCATION | 22 S GREENE ST | Baltimore, MD 21201-1544 | 410-328-4151 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.