Healthcare Provider Details

I. General information

NPI: 1972324606
Provider Name (Legal Business Name): COMMUNITY RADIOLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 620
BETHESDA MD
20817-1184
US

IV. Provider business mailing address

10461 MILL RUN CIR STE 1020
OWINGS MILLS MD
21117-5544
US

V. Phone/Fax

Practice location:
  • Phone: 888-601-0943
  • Fax: 301-662-5870
Mailing address:
  • Phone: 443-436-1221
  • Fax: 443-436-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALBERT VICTOR PORAMBO
Title or Position: PRESIDENT
Credential: MD
Phone: 301-774-4764