Healthcare Provider Details

I. General information

NPI: 1780172049
Provider Name (Legal Business Name): MD DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 GLEN PARK RD
NOTTINGHAM MD
21236-1019
US

IV. Provider business mailing address

1300 YORK RD STE 190D
LUTHERVILLE TIMONIUM MD
21093-6016
US

V. Phone/Fax

Practice location:
  • Phone: 410-248-0661
  • Fax:
Mailing address:
  • Phone: 443-946-9552
  • Fax: 443-288-5205

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: MINNIE CENIZA TAMPUS
Title or Position: PRACTICE MANAGER
Credential: CRNP
Phone: 443-288-5206