Healthcare Provider Details

I. General information

NPI: 1750933362
Provider Name (Legal Business Name): ADVANCED MOLECULAR IMAGING AND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 OAK MANOR DR STE 201
GLEN BURNIE MD
21061-5555
US

IV. Provider business mailing address

125 W SOUTH ST UNIT 1267
INDIANAPOLIS IN
46206-0009
US

V. Phone/Fax

Practice location:
  • Phone: 431-333-1894
  • Fax: 410-886-6991
Mailing address:
  • Phone: 443-333-1894
  • Fax: 443-839-0843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ANTHONY MORRIS
Title or Position: OWNER
Credential:
Phone: 410-231-3110