1710426390 NPI number — CHESAPEAKE OPEN MRI LLC

Table of content: (NPI 1710426390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710426390 NPI number — CHESAPEAKE OPEN MRI LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE OPEN 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:
CHESAPEAKE MEDICAL IMAGING
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:
1710426390
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 824106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-931-0400
Provider Business Mailing Address Fax Number:
410-931-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 LOVE POINT RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21666-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-643-3331
Provider Business Practice Location Address Fax Number:
443-249-3930
Provider Enumeration Date:
02/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BAGANZ
Authorized Official First Name:
MARK
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-571-0350

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)





Copyright © 2007-2024 www.npivalidator.com