Provider Demographics
NPI:1194924324
Name:ALPHA DIAGNOSTIC SERVICES, INC
Entity type:Organization
Organization Name:ALPHA DIAGNOSTIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-363-4301
Mailing Address - Street 1:9 GWYNNS MILL CT
Mailing Address - Street 2:SUITE F
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3527
Mailing Address - Country:US
Mailing Address - Phone:410-363-4301
Mailing Address - Fax:
Practice Address - Street 1:105 FARMSTEAD CT
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-2335
Practice Address - Country:US
Practice Address - Phone:410-363-4301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005196174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE021531A03Medicare PIN
DEE25340Medicare UPIN