Healthcare Provider Details

I. General information

NPI: 1386931855
Provider Name (Legal Business Name): CHESAPEAKE OPEN MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 BENSON AVE SUITE 100
BALTIMORE MD
21227-1056
US

IV. Provider business mailing address

3421 BENSON AVE SUITE 100
BALTIMORE MD
21227-1056
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-1880
  • Fax:
Mailing address:
  • Phone: 410-644-1880
  • 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: DR. MARK DOUGLAS BAGANZ
Title or Position: OFFICER
Credential: M.D.
Phone: 410-571-0350