Healthcare Provider Details

I. General information

NPI: 1184894024
Provider Name (Legal Business Name): SONOSCAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 10/18/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12F QUEEN ANNE WAY
CHESTER MD
21619-2538
US

IV. Provider business mailing address

12F QUEEN ANNE WAY
CHESTER MD
21619-2538
US

V. Phone/Fax

Practice location:
  • Phone: 443-870-3750
  • Fax:
Mailing address:
  • Phone: 443-870-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: NICK TKESHELASHVILI
Title or Position: PREISDENT AND CEO
Credential: MD
Phone: 443-710-7017