Healthcare Provider Details

I. General information

NPI: 1215879523
Provider Name (Legal Business Name): IN-DEPTH IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2518 VINEYARD LN
CROFTON MD
21114-1128
US

IV. Provider business mailing address

2518 VINEYARD LN
CROFTON MD
21114-1128
US

V. Phone/Fax

Practice location:
  • Phone: 240-593-8325
  • Fax:
Mailing address:
  • Phone: 240-593-8325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA RAQUEL JACKSON
Title or Position: OWNER
Credential: RDMS
Phone: 240-593-8325