1457300972 NPI number — REVEAL DIAGNOSTIC IMAGING OF PENNSYLVANIA LLC

Table of content: (NPI 1457300972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457300972 NPI number — REVEAL DIAGNOSTIC IMAGING OF PENNSYLVANIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REVEAL DIAGNOSTIC IMAGING OF PENNSYLVANIA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DIAGNOSTIC HEALTH READING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457300972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23137
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILTON HEAD ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29925-3137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-342-7100
Provider Business Mailing Address Fax Number:
843-342-5898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 BERKSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-478-8797
Provider Business Practice Location Address Fax Number:
610-478-8859
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAGLAYAN
Authorized Official First Name:
MURAT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
843-342-7100

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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