Healthcare Provider Details

I. General information

NPI: 1700829850
Provider Name (Legal Business Name): OLEAN RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MAIN ST OLEAN GENERAL HOSPITAL
OLEAN NY
14760-1513
US

IV. Provider business mailing address

251 NAJOLES RD STE A
MILLERSVILLE MD
21108-2519
US

V. Phone/Fax

Practice location:
  • Phone: 315-782-2620
  • Fax: 315-788-4980
Mailing address:
  • Phone: 443-274-2888
  • Fax: 443-274-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0019538120001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier02244984
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: GLAUCO MARESCA
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 315-265-4924