Healthcare Provider Details

I. General information

NPI: 1477591873
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3595
US

IV. Provider business mailing address

PO BOX 79915
BALTIMORE MD
21279-0915
US

V. Phone/Fax

Practice location:
  • Phone: 301-249-0022
  • Fax:
Mailing address:
  • Phone: 443-274-2900
  • Fax: 443-274-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN STALLINGS
Title or Position: MD/PRACTICE ADMINISTRATOR
Credential:
Phone: 301-249-0022