Organization
ADVANCED IMAGING OF PORT CHARLOTTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS M FABIAN MD (OWNER)
(941) 235-4646
Entity
Organization
Contact information
Practice address
2625 TAMIAMI TRL, UNIT 1, PORT CHARLOTTE, FL 33952-6478
(941) 235-4646
(941) 235-4655
Mailing address
2625 TAMIAMI TRL, UNIT 1, PORT CHARLOTTE, FL 33952-6478
(941) 235-4646
(941) 235-4655
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC8795
GROUP RAILROAD NUMBER
FL
Enumeration date
08/31/2005
Last updated
07/21/2022
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