Healthcare Provider Details

I. General information

NPI: 1134668767
Provider Name (Legal Business Name): CHESAPEAKE OPEN MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 IDLEWILD AVE SUITE 100
EASTON MD
21601-3881
US

IV. Provider business mailing address

PO BOX 824106
PHILADELPHIA PA
19182-4106
US

V. Phone/Fax

Practice location:
  • Phone: 410-820-8226
  • Fax: 410-921-3512
Mailing address:
  • Phone: 410-931-0400
  • Fax: 410-931-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK D. BAGANZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-571-0350