Provider Demographics
NPI:1285744870
Name:MD DIAGNOSTIC SPECIALIST, LLC
Entity type:Organization
Organization Name:MD DIAGNOSTIC SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-740-8848
Mailing Address - Street 1:668 N ORLANDO AVE
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4473
Mailing Address - Country:US
Mailing Address - Phone:407-740-8848
Mailing Address - Fax:407-740-0324
Practice Address - Street 1:668 N ORLANDO AVE
Practice Address - Street 2:SUITE 1005
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4473
Practice Address - Country:US
Practice Address - Phone:407-740-8848
Practice Address - Fax:407-740-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV3206OtherBCBS
FL9376098OtherAETNA
FL9376098OtherAETNA