1134211667 NPI number — CHESAPEAKE RADIOLOGY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134211667 NPI number — CHESAPEAKE RADIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE RADIOLOGY LLC
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:
OPEN MRI AND CT OF BEL AIR LLC
Provider Other Organization Name Type Code:
4
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:
1134211667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 S ATWOOD RD
Provider Second Line Business Mailing Address:
SUITE102
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-4172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-420-9980
Provider Business Mailing Address Fax Number:
410-420-9975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 S ATWOOD RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-4172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-420-9980
Provider Business Practice Location Address Fax Number:
410-420-9975
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADZIMA
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
410-420-9980

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25-0445 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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