Healthcare Provider Details

I. General information

NPI: 1740019280
Provider Name (Legal Business Name): UNIVERSITY OF MARYLAND DIAGNOSTIC IMAGING SPECIALISTS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/01/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 HARRY S TRUMAN DRIVE NORTH SUITE 150
LARGO MD
20774
US

IV. Provider business mailing address

110 S PACA ST RM 2-S135
BALTIMORE MD
21201-1642
US

V. Phone/Fax

Practice location:
  • Phone: 240-471-3200
  • Fax:
Mailing address:
  • Phone: 410-328-9130
  • Fax: 410-328-1190

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 Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKI CLOSE
Title or Position: ASSOCIATE ADMINISTRATOR
Credential:
Phone: 410-328-9130