Healthcare Provider Details

I. General information

NPI: 1780636928
Provider Name (Legal Business Name): ADVANCED MEDICAL SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 PROFESSIONAL PL SUITE 115
HYATTSVILLE MD
20785-2212
US

IV. Provider business mailing address

14201 LAUREL PARK DR SUITE 106
LAUREL MD
20707-5203
US

V. Phone/Fax

Practice location:
  • Phone: 301-918-0072
  • Fax: 301-918-1778
Mailing address:
  • Phone: 301-960-4645
  • Fax: 301-317-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberM232
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. JEAN EDMOND GAETJENS
Title or Position: PRESIDENT
Credential:
Phone: 301-960-4645