1093809212 NPI number — ALLEGANY IMAGING, PC

Table of content: (NPI 1093809212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093809212 NPI number — ALLEGANY IMAGING, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGANY IMAGING, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093809212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAVALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21504-3206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-964-1036
Provider Business Mailing Address Fax Number:
240-964-1048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12500 WILLOWBROOK RD
Provider Second Line Business Practice Location Address:
DEPT. OF RADIOLOGY
Provider Business Practice Location Address City Name:
CUMBERLAND
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21502-6393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-964-1036
Provider Business Practice Location Address Fax Number:
240-964-1048
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAPPAS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
NICKOLAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
240-964-1036

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 404554800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 404554802 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0210145000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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