MEDICARE: DIAGNOSTIC IMAGING ASSOCIATES P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	28258	KY
2	2085R0202X	Diagnostic Radiology Physician	35510	TN
3	2085R0202X	Diagnostic Radiology Physician	25573	NC
4	2085R0202X	Diagnostic Radiology Physician	35177	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	300009291	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	026544500	OTHER		DEPT OF LABOR
2	099837	OTHER		ANTHEM BLUE CROSS
3	1397456	OTHER		UMWA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	64794456	OTHER	KY	KY MED

General Provider Information

NPI Number	:	1043228471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC IMAGING ASSOCIATES P C

Provider Business Mailing Address
First Line	:	PO BOX 408
Second Line	:
City	:	NORTON
State	:	VA
Zip	:	24273
Country	:	US
Telephone Number	:	276-679-2729
Fax Number	:	276-679-0578

Provider Business Practice Location Address
First Line	:	935 VIRGINIA AVE NW
Second Line	:
City	:	NORTON
State	:	VA
Zip	:	24273-1818
Country	:	US
Telephone Number	:	276-679-2729
Fax Number	:	276-679-0578

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATHLEEN ANN DEPONTE
Credential	:	MD
Telephone Number	:	276-679-2729

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/13/2015

Similar Medicare Providers

1104024256 — KATHLEEN DEPONTE MD
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1679519698 — CHARLES JEFF BEGLEY MD
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1497622575 — SWVA PREMIER PEDIATRICS AND INTERNAL MEDICINE
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1629128640 — DR. JAMES WESLEY CAMPBELL DO
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1144223884 — MICHAEL RYAN WILLIAMS LCSW
Practice Location Address:

18 SEVENTH ST , PARK AVE CENTER, SUITE 207
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1053314799 — SUSAN GIBSON MYERS LCSW
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Directions to “DIAGNOSTIC IMAGING ASSOCIATES P C ” Practice Location

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