Provider Demographics
NPI:1073793394
Name:MEDICAL IMAGING DIAGNOSTICS
Entity Type:Organization
Organization Name:MEDICAL IMAGING DIAGNOSTICS
Other - Org Name:BREAST CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLEGGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-726-9006
Mailing Address - Street 1:819 MCKAY CT
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5713
Mailing Address - Country:US
Mailing Address - Phone:330-726-2071
Mailing Address - Fax:330-726-9007
Practice Address - Street 1:819 MCKAY CT
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5713
Practice Address - Country:US
Practice Address - Phone:330-726-0322
Practice Address - Fax:330-726-3260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL IMAGING DIAGNOSTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAB27454422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A16021Medicare UPIN