Healthcare Provider Details

I. General information

NPI: 1063699940
Provider Name (Legal Business Name): FREDERICK IMAGING CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46B THOMAS JOHNSON DR
FREDERICK MD
21702
US

IV. Provider business mailing address

PO BOX 5847
BALTIMORE MD
21282-5847
US

V. Phone/Fax

Practice location:
  • Phone: 301-696-1410
  • Fax: 301-696-1408
Mailing address:
  • Phone: 410-764-0912
  • Fax: 410-764-0647

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: MICHAEL KORANGY
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CFO
Phone: 410-764-0912