Provider Demographics
NPI:1366408239
Name:MONROE RADIOLOGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:MONROE RADIOLOGICAL ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MONROE RADIOLOGICAL ASSOC
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-436-5225
Mailing Address - Street 1:1160 CHILI AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3035
Mailing Address - Country:US
Mailing Address - Phone:585-436-5225
Mailing Address - Fax:
Practice Address - Street 1:1160 CHILI AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3035
Practice Address - Country:US
Practice Address - Phone:585-436-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00462208Medicaid
3726OtherBLUE CROSS BLUE SHIELD
G171OtherPREFERRED CARE HMO
G0180834590OtherBLUE CHOICE HMO
NY11963AMedicare ID - Type Unspecified