Healthcare Provider Details

I. General information

NPI: 1235963570
Provider Name (Legal Business Name): CHESAPEAKE OPEN MRI L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 BESTGATE RD STE 100
ANNAPOLIS MD
21401-3655
US

IV. Provider business mailing address

122 DEFENSE HWY STE 102
ANNAPOLIS MD
21401-7044
US

V. Phone/Fax

Practice location:
  • Phone: 443-221-4293
  • Fax:
Mailing address:
  • Phone:
  • 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: MARK D BAGANZ
Title or Position: PRESIDENT
Credential:
Phone: 410-571-0350