Provider Demographics
NPI:1538110804
Name:CENTRAL PENNSYLVANIA IMAGING, PC
Entity Type:Organization
Organization Name:CENTRAL PENNSYLVANIA IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALESTRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-224-2141
Mailing Address - Street 1:105 NASON DR
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1202
Mailing Address - Country:US
Mailing Address - Phone:814-224-2141
Mailing Address - Fax:
Practice Address - Street 1:105 NASON DR
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1202
Practice Address - Country:US
Practice Address - Phone:814-224-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019431910002Medicaid
PA067062Medicare ID - Type Unspecified