Healthcare Provider Details

I. General information

NPI: 1346246436
Provider Name (Legal Business Name): LEBANON DIAGNOSTIC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GATEWAY AVE
CHAMBERSBURG PA
17201-7351
US

IV. Provider business mailing address

960 ISABEL DRIVE
LEBANON PA
17042-7482
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-4999
  • Fax: 717-263-5522
Mailing address:
  • Phone: 717-306-4400
  • Fax: 717-306-4442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TONI COOPER
Title or Position: AM
Credential:
Phone: 754-206-6198