Healthcare Provider Details

I. General information

NPI: 1437320454
Provider Name (Legal Business Name): CHESAPEAKE OPEN MRI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DEFENSE HWY
ANNAPOLIS MD
21401-7069
US

IV. Provider business mailing address

122 DEFENSE HWY
ANNAPOLIS MD
21401-7069
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-0350
  • Fax:
Mailing address:
  • Phone: 410-571-0350
  • 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: M.D.
Phone: 410-571-0350