Healthcare Provider Details

I. General information

NPI: 1689701138
Provider Name (Legal Business Name): MOBILE DIAGNOSTIC TEST SERV INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 STATE ST SUITE 1400
ERIE PA
16501-1814
US

IV. Provider business mailing address

4950 GENESEE ST SUITE 180
BUFFALO NY
14225-5550
US

V. Phone/Fax

Practice location:
  • Phone: 814-480-5716
  • Fax: 814-480-5750
Mailing address:
  • Phone: 716-686-7100
  • Fax: 716-614-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN ROBINSON
Title or Position: PRESIDENT
Credential:
Phone: 716-614-3285