Provider Demographics
NPI:1740828532
Name:REVEAL DIAGNOSTIC IMAGING OF PENNSYLVANIA LLC
Entity type:Organization
Organization Name:REVEAL DIAGNOSTIC IMAGING OF PENNSYLVANIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHMET
Authorized Official - Middle Name:ENGIN
Authorized Official - Last Name:OLCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-815-7101
Mailing Address - Street 1:PO BOX 23137
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29925-3137
Mailing Address - Country:US
Mailing Address - Phone:843-342-7100
Mailing Address - Fax:
Practice Address - Street 1:450 CRESSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-6145
Practice Address - Country:US
Practice Address - Phone:610-650-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory