Organization
KETTERING NETWORK RADIOLOGISTS INC
Active
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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