Provider Demographics
NPI:1033146485
Name:DIAGNOSTIC BREAST CENTER, INC.
Entity Type:Organization
Organization Name:DIAGNOSTIC BREAST CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-718-6690
Mailing Address - Street 1:190 WELLES ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4968
Mailing Address - Country:US
Mailing Address - Phone:570-718-6690
Mailing Address - Fax:
Practice Address - Street 1:190 WELLES ST
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4968
Practice Address - Country:US
Practice Address - Phone:570-718-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA221883OtherFIRST PRIORITY
PA231553OtherHEALTH AMERICA
PA1549295OtherHIGHMARK BLUE SHIELD
PADB9358OtherRAILROAD MEDICARE
PA1549295OtherFIRST PRIORITY LIFE
PA3416377OtherAETNA
PA1010639010001Medicaid
PA657COtherGEISINGER HEALTH PLAN
PA1549295OtherFIRST PRIORITY LIFE