Organization
PINNACLE PHYSICIANS GROUP, LLC
Active
Other names
MNAP Diagnostic Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLE MEDOFF (EXECUTIVE DIRECTOR)
(215) 435-1709
Entity
Organization
Contact information
Practice address
9908 ROOSEVELT BLVD, PHILADELPHIA, PA 19115-1705
(215) 464-3300
(215) 464-5403
Mailing address
9908 ROOSEVELT BLVD, PHILADELPHIA, PA 19115-1705
(215) 464-3300
(215) 464-5403
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027993620001
—
PA
01
—
248882
MEDICARE GROUP PTAN
PA
01
—
3033848
HIGHMARK BLUECROSS
PA
01
—
3915101000
INDEPENDENCE BLUECROSS
PA
Enumeration date
02/14/2014
Last updated
05/29/2014
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