1710088075 NPI number — METROPOLITAN RADIOLOGY ASSOCIATES CHARTERED

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 1710088075 NPI number — METROPOLITAN RADIOLOGY ASSOCIATES CHARTERED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROPOLITAN RADIOLOGY ASSOCIATES CHARTERED
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:
1710088075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 BERWYN HOUSE RD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
COLLEGE PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-220-0150
Provider Business Mailing Address Fax Number:
301-220-1032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3327 SUPERIOR LANE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-262-2202
Provider Business Practice Location Address Fax Number:
301-262-0382
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MULLEN
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
301-614-0595

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 356801600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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