Provider Demographics
NPI:1558784538
Name:VASCULAR DIAGNOSTIC CENTER PC
Entity Type:Organization
Organization Name:VASCULAR DIAGNOSTIC CENTER PC
Other - Org Name:CHARTERED VASCULAR DIAGNOSTIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-343-1900
Mailing Address - Street 1:100 MYLES STANDISH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-7340
Mailing Address - Country:US
Mailing Address - Phone:508-880-3700
Mailing Address - Fax:
Practice Address - Street 1:103 SQUIRREL RUN
Practice Address - Street 2:
Practice Address - City:CLARKS GREEN
Practice Address - State:PA
Practice Address - Zip Code:18411-8960
Practice Address - Country:US
Practice Address - Phone:570-343-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VASCULAR DIAGNOSTIC CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty