# SOURCE DIAGNOSTICS OF PENNSYLVANIA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053619775
- **Authorized official:** MS. KATHLEEN ANN BARRY (C.O.O.)
- **Authorized official phone:** (440) 645-7822

## Contact information

- **Practice address:** 175 SNYDER RD, HERMITAGE, PA 16148-3431
- **Practice address phone:** (440) 645-7822
- **Practice address fax:** (440) 542-9482
- **Mailing address:** 5275 NAIMAN PKWY, SUITE E, SOLON, OH 44139-1029
- **Mailing address phone:** (440) 645-7822
- **Mailing address fax:** (440) 542-9482

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 03/03/2011
- **Last updated:** 04/12/2012