Healthcare Provider Details

I. General information

NPI: 1477586055
Provider Name (Legal Business Name): PROFESIONAL MEDICAL IMAGING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 FRANKLIN SQUARE DR
BALTIMORE MD
21236-5915
US

IV. Provider business mailing address

9900 FRANKLIN SQUARE DR
BALTIMORE MD
21236-5915
US

V. Phone/Fax

Practice location:
  • Phone: 410-931-4738
  • Fax: 410-931-2989
Mailing address:
  • Phone: 410-931-4738
  • Fax: 410-931-2989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MULREANSY
Title or Position: PRESIDENT
Credential:
Phone: 410-931-4738