Healthcare Provider Details

I. General information

NPI: 1528012119
Provider Name (Legal Business Name): GERMANTOWN OUTPATIENT IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19731 GERMANTOWN RD SUITE 102
GERMANTOWN MD
20874-1203
US

IV. Provider business mailing address

19650 CLUB HOUSE RD SUITE 201
MONTGOMRY VILLAGE MD
20886-3039
US

V. Phone/Fax

Practice location:
  • Phone: 301-948-5700
  • Fax: 240-683-3612
Mailing address:
  • Phone: 301-948-5700
  • Fax: 240-683-3612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: LARRY BUSCHING
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 301-948-5700