Provider Demographics
NPI:1306240692
Name:INTERNAL MEDICINE DIAGNOSTICS INC
Entity type:Organization
Organization Name:INTERNAL MEDICINE DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:TROSTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-419-8084
Mailing Address - Street 1:881 HILLS PLZ
Mailing Address - Street 2:SUITE 530
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4213
Mailing Address - Country:US
Mailing Address - Phone:814-419-8084
Mailing Address - Fax:814-419-8053
Practice Address - Street 1:881 HILLS PLZ
Practice Address - Street 2:SUITE 530
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4213
Practice Address - Country:US
Practice Address - Phone:814-419-8084
Practice Address - Fax:814-419-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory