Healthcare Provider Details

I. General information

NPI: 1780401356
Provider Name (Legal Business Name): ALLEGANY IMAGING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 WILLOWBROOK RD
CUMBERLAND MD
21502-2559
US

IV. Provider business mailing address

PO BOX 3206
LAVALE MD
21504-3206
US

V. Phone/Fax

Practice location:
  • Phone: 240-964-1035
  • Fax: 240-964-1105
Mailing address:
  • Phone: 240-964-1035
  • Fax: 240-964-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: KARON L BAER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 240-964-1035