Healthcare Provider Details

I. General information

NPI: 1255308441
Provider Name (Legal Business Name): VASCULAR DIAGNOSTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 QUINCY AVE
SCRANTON PA
18510-1724
US

IV. Provider business mailing address

100 MYLES STANDISH BLVD
TAUNTON MA
02780-7321
US

V. Phone/Fax

Practice location:
  • Phone: 570-340-2256
  • Fax:
Mailing address:
  • Phone: 508-880-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TERENCE A COCHRAN
Title or Position: PRESIDENT
Credential: MD
Phone: 570-343-1900