Provider Demographics
NPI:1285636092
Name:PACK, DAINA B (MD)
Entity Type:Individual
Prefix:DR
First Name:DAINA
Middle Name:B
Last Name:PACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2770
Mailing Address - Fax:410-841-6251
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 235
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2770
Practice Address - Fax:410-841-6251
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00456762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA11OtherAAD PG COUNTY
MD10690011OtherBCBS
MD2622593OtherAETNA HMO/POS
MD735COtherAAD SHIPLEYS
MD277NOtherAAD AA COUNTY
MD8317071OtherAETNA PPO
MD10690011OtherBCBS
MD735COtherAAD SHIPLEYS
MD2622593OtherAETNA HMO/POS