Healthcare Provider Details

I. General information

NPI: 1265499784
Provider Name (Legal Business Name): MRI OF WILMINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N UNION ST
WILMINGTON DE
19805-2736
US

IV. Provider business mailing address

1601 MILLTOWN RD SUITE 13
WILMINGTON DE
19808-4027
US

V. Phone/Fax

Practice location:
  • Phone: 302-427-9855
  • Fax: 302-427-9549
Mailing address:
  • Phone: 302-993-2330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA L PEACOCK
Title or Position: PROJECT MANAGER
Credential: MS, MS
Phone: 302-993-2330