Basic Information
| Provider Information | |||||||||
| NPI: | 1649778614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RDR RADIOLOGY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4695 MAIN ST STE 5 | ||||||||
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| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066061802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035385233 | ||||||||
| FaxNumber: | 2035385246 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 POST RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068246232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034189680 | ||||||||
| FaxNumber: | 2032549244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | RUSSO | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2035385233 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 |
No ID Information.