Basic Information
| Provider Information | |||||||||
| NPI: | 1356352660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGICAL ASSOCIATES MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 SAMARITAN DRIVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083710390 | ||||||||
| FaxNumber: | 4083710462 | ||||||||
| Practice Location | |||||||||
| Address1: | 2410 SAMARITAN DRIVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083710728 | ||||||||
| FaxNumber: | 4083711164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | ANUP | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4083718346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | GR0012480 | 05 | CA | MEDICAID | CT0214 | 01 | CA | MEDICARE ID | OTHER |