Organization
MOUNTAINEER RADIOLOGISTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS ZEKAN MD (PRESIDENT)
(304) 951-1588
Entity
Organization
Contact information
Practice address
1306 KANAWHA BLVD E, BUILDING 2, CHARLESTON, WV 25301-3000
(304) 951-1588
Mailing address
PO BOX 1111, CHARLESTON, WV 25324-1111
(304) 951-1588
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001711957
BCBS
WV
05
—
1154320869
—
VA
05
—
3810002431
—
WV
05
—
3810006507
—
WV
05
—
3810006508
—
WV
Enumeration date
07/15/2005
Last updated
07/16/2015
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