Organization
AVALON RADIOLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HEATHER J ROSE MD (PRESIDENT)
(304) 497-2500
Entity
Organization
Contact information
Practice address
202 MAPLEWOOD AVE, RADIOLOGY DEPARTMENT, RONCEVERTE, WV 24970-1334
(304) 497-2500
Mailing address
202 MAPLEWOOD AVE, RADIOLOGY DEPARTMENT, RONCEVERTE, WV 24970-1334
(304) 497-2500
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
WV 17711
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120343000
—
WV
01
—
17711
STATE LICENSE
WV
Enumeration date
03/26/2007
Last updated
10/18/2007
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