Healthcare Provider Details

I. General information

NPI: 1689618951
Provider Name (Legal Business Name): DIAGNOSTIC MEDICAL SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S OLD BALTIMORE PIKE SUITE 104
NEWARK DE
19702-1540
US

IV. Provider business mailing address

25 S OLD BALTIMORE PIKE SUITE 104
NEWARK DE
19702-1540
US

V. Phone/Fax

Practice location:
  • Phone: 302-292-2700
  • Fax: 302-292-2702
Mailing address:
  • Phone: 302-292-2700
  • Fax: 302-292-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number1989025931
License Number StateDE

VIII. Authorized Official

Name: MR. JOHN J GRAY III
Title or Position: PRESIDENT
Credential: RDMS
Phone: 302-292-2700