Healthcare Provider Details

I. General information

NPI: 1114466745
Provider Name (Legal Business Name): CHESAPEAKE OPEN MRI L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8114 SANDPIPER CIR SUITE 106
NOTTINGHAM MD
21236-4934
US

IV. Provider business mailing address

122 DEFENSE HWY STE 102
ANNAPOLIS MD
21401-7044
US

V. Phone/Fax

Practice location:
  • Phone: 443-693-5110
  • Fax: 443-693-7925
Mailing address:
  • Phone: 410-931-0400
  • Fax: 410-931-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK D. BAGANZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-571-0350