Provider Demographics
NPI:1437227816
Name:ALPHA DIAGNOSTIC SERVICES INC
Entity type:Organization
Organization Name:ALPHA DIAGNOSTIC SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIKVASHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-363-4301
Mailing Address - Street 1:9 GWYNNS MILL CT
Mailing Address - Street 2:SUITE F
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3527
Mailing Address - Country:US
Mailing Address - Phone:410-363-4301
Mailing Address - Fax:410-363-4302
Practice Address - Street 1:105 FARMSTEAD CT
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-2335
Practice Address - Country:US
Practice Address - Phone:302-363-3697
Practice Address - Fax:410-363-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE06-92169-10-000335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1437227816Medicaid