Healthcare Provider Details

I. General information

NPI: 1831283050
Provider Name (Legal Business Name): OAKLAND MRI CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 N. FOURTH ST.
OAKLAND MD
21550
US

IV. Provider business mailing address

259 N. FOURTH ST.
OAKLAND MD
21550
US

V. Phone/Fax

Practice location:
  • Phone: 301-533-4674
  • Fax: 301-533-1077
Mailing address:
  • Phone: 301-533-4674
  • Fax: 301-533-1077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number11915560
License Number StateMD

VIII. Authorized Official

Name: DR. JOHN NICKOLAS PAPPAS
Title or Position: RADIOLOGIST/BOARD MEMBER
Credential: M.D.
Phone: 240-964-1045