Healthcare Provider Details

I. General information

NPI: 1932167178
Provider Name (Legal Business Name): ADVANCED RADIOLOGY P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/09/2024
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CROSSROADS DR STE 100
OWINGS MILLS MD
21117-5484
US

IV. Provider business mailing address

10461 MILL RUN CIR STE 1200
OWINGS MILLS MD
21117-4204
US

V. Phone/Fax

Practice location:
  • Phone: 888-972-9700
  • Fax: 443-436-1500
Mailing address:
  • Phone: 443-436-1116
  • Fax: 443-436-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID I SAFFERMAN
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 443-436-1215