Organization
MARTINSBURG RADIOLOGY ASSOC INC
Active
Organization
MARTINSBURG RADIOLOGY ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIMITRI MISAILIDIS MD (PRESIDENT)
(304) 263-4967
Entity
Organization
Contact information
Practice address
300 FOXCROFT AVE, SUITE 202B, MARTINSBURG, WV 25401-5341
(304) 263-4967
(304) 267-0974
Mailing address
300 FOXCROFT AVE, SUITE 202B, MARTINSBURG, WV 25401-5341
(304) 263-4967
(304) 267-0974
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008749000
—
WV
01
—
001709764
MT ST BCBS
WV
05
—
134171500
—
MD
Enumeration date
09/09/2005
Last updated
03/25/2009
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