Healthcare Provider Details

I. General information

NPI: 1043340672
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15119 GANLEY RD
BOYDS MD
20841-9466
US

IV. Provider business mailing address

15119 GANLEY RD
BOYDS MD
20841-9466
US

V. Phone/Fax

Practice location:
  • Phone: 301-515-1264
  • Fax: 301-515-0069
Mailing address:
  • Phone: 301-515-1264
  • Fax: 301-515-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN LANDON CARTER
Title or Position: PRESIDENT
Credential: RVT RDCS
Phone: 301-801-8800