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Organization

KETTERING NETWORK RADIOLOGISTS INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RONALD J FADELL MD (PRESIDENT)
(937) 296-7202
Entity
Organization

Contact information

Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 296-7202
Mailing address
L-3402, COLUMBUS, OH 43260
(614) 430-5707

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000006173
ANTHEM
05
0383160
OH
01
CB4569
MEDICARE RAILROAD
Enumeration date
05/09/2006
Last updated
04/22/2013
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