MEDICARE: ORLANDO DIAGNOSTIC CENTER INC

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	2471S1302X	Sonography Radiologic Technologist	3001575478	FL
2	2085R0202X	Diagnostic Radiology Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982673414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO DIAGNOSTIC CENTER INC

Provider Business Mailing Address
First Line	:	450 W STATE ROAD 434
Second Line	:	SUITE 1020
City	:	LONGWOOD
State	:	FL
Zip	:	32750
Country	:	US
Telephone Number	:	321-207-0200
Fax Number	:	321-262-0924

Provider Business Practice Location Address
First Line	:	450 W STATE ROAD 434
Second Line	:	SUITE 1020
City	:	LONGWOOD
State	:	FL
Zip	:	32750-5118
Country	:	US
Telephone Number	:	321-207-0200
Fax Number	:	321-206-0924

Authorized Official
Title or Position	:	OWNER
Name	:	WASIM AHMAR
Credential	:	M.D
Telephone Number	:	321-207-0200

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	02/22/2018

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