Organization
MARYLAND NUCLEAR MEDICINE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PABLO E DIBOS M.D. (PRESIDENT)
(410) 532-8000
Entity
Organization
Contact information
Practice address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2905
(410) 532-8000
Mailing address
5601 LOCH RAVEN BLVD, BALTIMORE, MD 21239-2905
(410) 532-8000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207U00000X
Nuclear Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LZ63MA
BLUE SHIELD
MD
01
—
T294
GHI
DC
Enumeration date
12/29/2006
Last updated
09/11/2025
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