Provider Demographics
NPI:1053709956
Name:CORYELL INTERVENTIONAL RADIOLOGY, LLC
Entity type:Organization
Organization Name:CORYELL INTERVENTIONAL RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:CORYELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-804-6218
Mailing Address - Street 1:1786 HARMONYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-8551
Mailing Address - Country:US
Mailing Address - Phone:610-804-6218
Mailing Address - Fax:
Practice Address - Street 1:1786 HARMONYVILLE RD
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-8551
Practice Address - Country:US
Practice Address - Phone:610-804-6218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4443362085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty