Basic Information
| Provider Information | |||||||||
| NPI: | 1972583052 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VENANGO DIAGNOSTIC IMAGING, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 49 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152300049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129375726 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 FAIRFIELD DR | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163462130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146771410 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BITTNER | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8146768130 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.