Healthcare Provider Details

I. General information

NPI: 1457389694
Provider Name (Legal Business Name): MEDICAL DIAGNOSTIC SERVICES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CRANBERRY ST
ERIE PA
16507-1067
US

IV. Provider business mailing address

90 CHAMBER PLZ
CHARLEROI PA
15022-1620
US

V. Phone/Fax

Practice location:
  • Phone: 814-480-8040
  • Fax: 814-480-8043
Mailing address:
  • Phone: 724-489-0263
  • Fax: 724-489-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TONYA L REBAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 724-489-0263