Healthcare Provider Details

I. General information

NPI: 1396714622
Provider Name (Legal Business Name): REGIONAL RADIOLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 INTERSTATE PKWY
BRADFORD PA
16701-1036
US

IV. Provider business mailing address

251 NAJOLES RD STE A
MILLERSVILLE MD
21108-2519
US

V. Phone/Fax

Practice location:
  • Phone: 814-368-4143
  • Fax: 443-274-2391
Mailing address:
  • Phone: 443-274-2888
  • Fax: 443-274-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

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