Healthcare Provider Details

I. General information

NPI: 1851664122
Provider Name (Legal Business Name): CHESAPEAKE OPEN MRI L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 WILKENS AVE SUITE 103
BALTIMORE MD
21229-4843
US

IV. Provider business mailing address

122 DEFENSE HWY STE 102
ANNAPOLIS MD
21401-7044
US

V. Phone/Fax

Practice location:
  • Phone: 410-242-8335
  • Fax: 410-242-8339
Mailing address:
  • Phone:
  • Fax: 410-242-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD44496
License Number StateMD

VIII. Authorized Official

Name: DR. MARK BAGANZ
Title or Position: OFFICER
Credential: M.D.
Phone: 410-571-0350