Healthcare Provider Details

I. General information

NPI: 1952465585
Provider Name (Legal Business Name): UNITED RADIOLOGY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

6615 REISTERSTOWN RD STE 305
BALTIMORE MD
21215-2686
US

V. Phone/Fax

Practice location:
  • Phone: 410-764-0912
  • Fax:
Mailing address:
  • Phone: 410-764-0912
  • Fax: 410-764-0647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KORANGY
Title or Position: CFO
Credential:
Phone: 410-764-0912