Provider Demographics
NPI:1952372526
Name:WELLSBORO IMAGING INC
Entity Type:Organization
Organization Name:WELLSBORO IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOGANIERO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-723-0163
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-0021
Mailing Address - Country:US
Mailing Address - Phone:570-723-0163
Mailing Address - Fax:
Practice Address - Street 1:32-36 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1840
Practice Address - Country:US
Practice Address - Phone:570-723-0163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
170719OtherHIGHMARK BS
PACK4241OtherTAVELERS MEDICARE
PACK4241OtherTAVELERS MEDICARE