Organization
SALEM RADIOLOGISTS, INC.
Active
Organization
SALEM RADIOLOGISTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA S. DERMOTTA (MANAGER)
(330) 337-6140
Entity
Organization
Contact information
Practice address
1995 E STATE ST, MEDICAL IMAGING DEPT., SALEM, OH 44460-2423
(330) 337-6140
(330) 337-1071
Mailing address
2094 E STATE ST, SUITE E, SALEM, OH 44460-4409
(330) 337-6140
(330) 337-1071
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000163490
ANTHEM PROVIDER GROUP NUM
OH
05
—
0126929
—
OH
01
—
CB4620
RAILROAD MEDICARE GROUP N
OH
Enumeration date
10/23/2006
Last updated
04/20/2008
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