Healthcare Provider Details

I. General information

NPI: 1164961744
Provider Name (Legal Business Name): CHESAPEAKE OPEN MRI L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVE SUITE 100
ANNAPOLIS MD
21401-1001
US

IV. Provider business mailing address

122 DEFENSE HWY STE 102
ANNAPOLIS MD
21401-7044
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-9715
  • Fax: 410-266-9717
Mailing address:
  • Phone: 410-931-0400
  • Fax: 410-931-1009

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: MR. MARK D. BAGANZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-571-0350