Organization
PINNACLE PHYSICIANS GROUP, LLC
Active
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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