Provider Demographics
NPI:1336276021
Name:DIAGNOSTIC MANAGEMENT ASSOCIATES INC
Entity type:Organization
Organization Name:DIAGNOSTIC MANAGEMENT ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:B
Authorized Official - Last Name:O'NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-662-2913
Mailing Address - Street 1:2110 ROCKY GORGE COURT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5914
Mailing Address - Country:US
Mailing Address - Phone:301-662-2913
Mailing Address - Fax:301-695-6928
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-868-9575
Practice Address - Fax:301-868-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD3316801261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1201OtherBLUE SHIELD
MD5455511 00Medicaid
MD517452Medicare PIN