Healthcare Provider Details

I. General information

NPI: 1285833269
Provider Name (Legal Business Name): MGMC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW DEPARTMENT OF RADIOLOGY
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

2115 WISCONSIN AVE NW SUITE 300
WASHINGTON DC
20007-2265
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-1400
  • Fax: 202-444-7993
Mailing address:
  • Phone: 202-444-1400
  • Fax: 202-444-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW WEISS
Title or Position: DIRECTOR
Credential:
Phone: 202-444-7690