Provider Demographics
NPI:1164472288
Name:DIAMOND TRAUMA & PAIN MANGEMENT, P.C.
Entity Type:Organization
Organization Name:DIAMOND TRAUMA & PAIN MANGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAYLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-782-8760
Mailing Address - Street 1:PO BOX 7166
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-0166
Mailing Address - Country:US
Mailing Address - Phone:215-782-8760
Mailing Address - Fax:215-635-7130
Practice Address - Street 1:8080 OLD YORK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1421
Practice Address - Country:US
Practice Address - Phone:215-782-8760
Practice Address - Fax:215-635-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103717Medicare PIN