Provider Demographics
NPI:1700829850
Name:OLEAN RADIOLOGY, PC
Entity Type:Organization
Organization Name:OLEAN RADIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLAUCO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-265-4924
Mailing Address - Street 1:251 NAJOLES RD STE A
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2519
Mailing Address - Country:US
Mailing Address - Phone:443-274-2888
Mailing Address - Fax:443-274-2391
Practice Address - Street 1:515 MAIN ST
Practice Address - Street 2:OLEAN GENERAL HOSPITAL
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1513
Practice Address - Country:US
Practice Address - Phone:315-782-2620
Practice Address - Fax:315-788-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019538120001Medicaid
NY02244984Medicaid