Registry details
Type
Individual
Primary specialty
Radiology, Diagnostic Radiology
Enumerated
Jan 13, 2006
License(s)
25MA08191400 (NJ), 25MA08191400 (NJ), MD026515E (PA), MD026515E (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 380 OXFORD VALLEY RD ATTN: RADIOLOGY | Langhorne, PA 19047-8304 | 215-612-2610 |
| MAILING | PO BOX 782743 ATTN: CREDENTIALING | Philadelphia, PA 19178-2743 | 602-910-6887 |
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