Provider Demographics
NPI:1982673414
Name:ORLANDO DIAGNOSTIC CENTER INC
Entity Type:Organization
Organization Name:ORLANDO DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-207-0200
Mailing Address - Street 1:450 W STATE ROAD 434
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750
Mailing Address - Country:US
Mailing Address - Phone:321-207-0200
Mailing Address - Fax:321-262-0924
Practice Address - Street 1:450 W STATE ROAD 434
Practice Address - Street 2:SUITE 1020
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5118
Practice Address - Country:US
Practice Address - Phone:321-207-0200
Practice Address - Fax:321-206-0924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORLANDO DIAGNOSTIC CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-16
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
FL30015754782471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0302Medicare ID - Type Unspecified