Organization
DIAGNOSTIC IMAGING CONSULTANTS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CONSTANTINE PETROCHKO MD (AUTHORIZED OFFICIAN)
(724) 588-2100
Entity
Organization
Contact information
Practice address
110 N MAIN ST, GREENVILLE, PA 16125-1726
(724) 588-2100
Mailing address
PO BOX 73985, CLEVELAND, OH 44193-0002
(866) 338-6467
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000158604
BC BS
OH
05
—
0011394260023
—
PA
05
—
0712812
—
OH
01
—
151892
BC BS
PA
Enumeration date
02/13/2006
Last updated
07/24/2008
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