Basic Information
Provider Information | |||||||||
NPI: | 1215928882 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RADVANY | ||||||||
FirstName: | MARTIN | ||||||||
MiddleName: | GEZA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 7623 | ||||||||
Address2: |   | ||||||||
City: | NAPLES | ||||||||
State: | FL | ||||||||
PostalCode: | 341017623 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3057127229 | ||||||||
FaxNumber: | 3053971139 | ||||||||
Practice Location | |||||||||
Address1: | 20900 BISCAYNE BLVD | ||||||||
Address2: |   | ||||||||
City: | AVENTURA | ||||||||
State: | FL | ||||||||
PostalCode: | 331801407 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3056827000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2005 | ||||||||
LastUpdateDate: | 07/05/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/05/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | ME122178 | FL | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 27553 | SC | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | L1173 | TX | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | MD453589 | PA | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | D48191 | MD | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | ME122178 | FL | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | E-11049 | AR | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085N0700X | ME122178 | FL | Y |   | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
ID | Type | State | Issuer | Description | 102991632 | 05 | PA |   | MEDICAID | Q00222997 | 01 | FL | RAILROAD MEDICARE | OTHER | 680451901 | 05 | MD |   | MEDICAID | N8828 | 01 | FL | FLORIDA MEDICARE | OTHER | 10434991 | 01 | FL | CAQH | OTHER | 111544500 | 05 | FL |   | MEDICAID | EFZ2Z | 01 | FL | FLORIDA BCBS | OTHER | PO1739390 | 01 | PA | RAILROAD | OTHER | 680451900 | 05 | MD |   | MEDICAID |