1689783185 NPI number — PROGRESSIVE MRI, LLC

Table of content: (NPI 1689783185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689783185 NPI number — PROGRESSIVE MRI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE MRI, 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:
PROGRESSIVE MRI
Provider Other Organization Name Type Code:
3
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:
1689783185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3201 JERMANTOWN RD STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22030-2885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-667-8600
Provider Business Mailing Address Fax Number:
703-667-8601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1185 IMPERIAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-733-1477
Provider Business Practice Location Address Fax Number:
301-733-7758
Provider Enumeration Date:
08/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STARR
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
703-667-8612

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  0003669948 , 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)