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NPI Code Detail

MEDICARE: WELLSBORO IMAGING INC

MEDICARE: WELLSBORO IMAGING INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CK4241OTHERPATAVELERS MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1170719OTHERHIGHMARK BS

General Provider Information

NPI Number : 1952372526
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLSBORO IMAGING INC
Provider Business Mailing Address
First Line : PO BOX 21
Second Line :
City : WELLSBORO
State : PA
Zip : 16901-0021
Country : US
Telephone Number : 570-723-0163
Fax Number :
Provider Business Practice Location Address
First Line : 32-36 CENTRAL AVE
Second Line :
City : WELLSBORO
State : PA
Zip : 16901-1840
Country : US
Telephone Number : 570-723-0163
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ENRICO DOGANIERO
Credential : DO
Telephone Number : 570-723-0163
Provider Enumeration Date : 01/31/2006
Last Update Date : 10/16/2007

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Directions to “WELLSBORO IMAGING INC ” Practice Location

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