Healthcare Provider Details

I. General information

NPI: 1033434808
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MERCANTILE LN SUITE 150
LARGO MD
20774-5380
US

IV. Provider business mailing address

8116 GOOD LUCK RD
LANHAM MD
20706-3502
US

V. Phone/Fax

Practice location:
  • Phone: 301-249-0022
  • Fax:
Mailing address:
  • Phone: 301-459-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. CHRISTOPHER DUGAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 301-249-0022