Provider Demographics
NPI:1508832593
Name:PROFESSIONAL DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:PROFESSIONAL DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTACT PERSON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SZUMEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-392-7086
Mailing Address - Street 1:106 BOW ST
Mailing Address - Street 2:UNION HOSPITAL
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5544
Mailing Address - Country:US
Mailing Address - Phone:410-392-7086
Mailing Address - Fax:410-392-4704
Practice Address - Street 1:106 BOW ST
Practice Address - Street 2:UNION HOSPITAL
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5544
Practice Address - Country:US
Practice Address - Phone:410-392-7086
Practice Address - Fax:410-392-4704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD819LMedicare ID - Type UnspecifiedGROUP