Provider Demographics
NPI:1245241546
Name:FETAL DIAGNOSTIC CENTER OF ORLANDO, INC.
Entity Type:Organization
Organization Name:FETAL DIAGNOSTIC CENTER OF ORLANDO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-897-3737
Mailing Address - Street 1:615 E PRINCETON ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1456
Mailing Address - Country:US
Mailing Address - Phone:407-897-3737
Mailing Address - Fax:407-897-3711
Practice Address - Street 1:615 E PRINCETON ST
Practice Address - Street 2:SUITE 240
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1456
Practice Address - Country:US
Practice Address - Phone:407-897-3737
Practice Address - Fax:407-897-3711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBK532AMedicare PIN