Healthcare Provider Details

I. General information

NPI: 1922497890
Provider Name (Legal Business Name): SHARP IMAGING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4707 BENSON AVE STE 4
BALTIMORE MD
21227-1425
US

IV. Provider business mailing address

4707 BENSON AVE STE 4
BALTIMORE MD
21227-1425
US

V. Phone/Fax

Practice location:
  • Phone: 410-242-2440
  • Fax: 877-614-6255
Mailing address:
  • Phone: 410-242-2440
  • Fax: 877-614-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KEVIN NOONE
Title or Position: DIRECTOR
Credential:
Phone: 410-242-2440