Basic Information
| Provider Information | |||||||||
| NPI: | 1467873968 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUANTUM IMAGING AND THERAPEUTIC ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 629D LOWTHER RD | ||||||||
| Address2: | |||||||||
| City: | LEWISBERRY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173399527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179325200 | ||||||||
| FaxNumber: | 7179323095 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 NEW LINDEN HILL RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198082953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179325200 | ||||||||
| FaxNumber: | 7179323095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2013 | ||||||||
| LastUpdateDate: | 12/31/2013 | ||||||||
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| AuthorizedOfficialLastName: | BERGEY | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7179325200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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.