Healthcare Provider Details

I. General information

NPI: 1780635896
Provider Name (Legal Business Name): MARK S COLELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CARLISLE ST DEPT OF RADIOLOGY
NATRONA HEIGHTS PA
15065
US

IV. Provider business mailing address

7 ACEE DRIVE
NATRONA HEIGHTS PA
15065
US

V. Phone/Fax

Practice location:
  • Phone: 724-334-4774
  • Fax: 724-334-4776
Mailing address:
  • Phone: 800-223-5544
  • Fax: 724-294-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD044762L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD044762L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberMD044762L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD044762L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD044762L
License Number StatePA
# 6
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberMD044762L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0012812470006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier722031
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: