Healthcare Provider Details

I. General information

NPI: 1508012121
Provider Name (Legal Business Name): VASCULAR DIAGNOSTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SOUTH DENNIS ROAD
CAPE MAY COURT HOUSE NJ
08210-2193
US

IV. Provider business mailing address

100 MYLES STANDISH BLVD
TAUNTON MA
02780-7321
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-5000
  • Fax: 215-627-3199
Mailing address:
  • Phone: 508-880-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TERENCE A COCHRAN
Title or Position: PRESIDENT
Credential: MD
Phone: 570-288-8881