Healthcare Provider Details

I. General information

NPI: 1588952337
Provider Name (Legal Business Name): RADCARE OF MARYLAND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W BELVEDERE AVE
BALTIMORE MD
21215-5216
US

IV. Provider business mailing address

13737 NOEL RD #1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9000
  • Fax: 214-712-2487
Mailing address:
  • Phone: 954-838-2371
  • 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. RUSSELL HARRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371