Provider Demographics
NPI:1871886838
Name:PALM DIAGNOSTICS INC
Entity type:Organization
Organization Name:PALM DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:DILIM
Authorized Official - Last Name:ILOANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-675-9824
Mailing Address - Street 1:5021 ROME RED WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6847
Mailing Address - Country:US
Mailing Address - Phone:301-675-9824
Mailing Address - Fax:
Practice Address - Street 1:5021 ROME RED WAY
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6847
Practice Address - Country:US
Practice Address - Phone:301-675-9824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27-0560261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile