Healthcare Provider Details

I. General information

NPI: 1457300972
Provider Name (Legal Business Name): REVEAL DIAGNOSTIC IMAGING OF PENNSYLVANIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BERKSHIRE BLVD SUITE 500
WYOMISSING PA
19610-1227
US

IV. Provider business mailing address

PO BOX 23137
HILTON HEAD ISLAND SC
29925-3137
US

V. Phone/Fax

Practice location:
  • Phone: 610-478-8797
  • Fax: 610-478-8859
Mailing address:
  • Phone: 843-342-7100
  • Fax: 843-342-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MURAT CAGLAYAN
Title or Position: PRESIDENT
Credential:
Phone: 843-342-7100