1508012121 NPI number — VASCULAR DIAGNOSTIC CENTER PC

Table of content: (NPI 1508012121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508012121 NPI number — VASCULAR DIAGNOSTIC CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR DIAGNOSTIC CENTER PC
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:
Provider Other Organization Name Type Code:
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:
1508012121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MYLES STANDISH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAUNTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02780-7321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-880-3700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 SOUTH DENNIS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPE MAY COURT HOUSE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08210-2193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-829-5000
Provider Business Practice Location Address Fax Number:
215-627-3199
Provider Enumeration Date:
08/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COCHRAN
Authorized Official First Name:
TERENCE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-288-8881

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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