Basic Information
| Provider Information | |||||||||
| NPI: | 1508012121 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VASCULAR DIAGNOSTIC CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MYLES STANDISH BLVD | ||||||||
| Address2: | |||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027807321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088803700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8 SOUTH DENNIS ROAD | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082102193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158295000 | ||||||||
| FaxNumber: | 2156273199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2008 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | COCHRAN | ||||||||
| AuthorizedOfficialFirstName: | TERENCE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5702888881 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085U0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0204X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
No ID Information.