Provider Demographics
NPI:1922017490
Name:MD DIAGNOSTIC SPECIALISTS
Entity Type:Organization
Organization Name:MD DIAGNOSTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-419-0004
Mailing Address - Street 1:668 N ORLANDO AVE
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:668 N ORLANDO AVE
Practice Address - Street 2:SUITE 1010
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4473
Practice Address - Country:US
Practice Address - Phone:407-740-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90201225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D87109Medicare UPIN
FL49077XMedicare ID - Type Unspecified