Basic Information
| Provider Information | |||||||||
| NPI: | 1003804626 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORT WASHINGTON RADIOLOGICAL ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 OREGON PIKE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172933223 | ||||||||
| FaxNumber: | 7173902455 | ||||||||
| Practice Location | |||||||||
| Address1: | 1244 FORT WASHINGTON AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FORT WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190341743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155421247 | ||||||||
| FaxNumber: | 2155427936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | SEELAUS | ||||||||
| AuthorizedOfficialFirstName: | JERE | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2155421247 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.