Healthcare Provider Details

I. General information

NPI: 1699839860
Provider Name (Legal Business Name): NIGHTTIME RADIOLOGY NORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8125 RITCHIE HWY STE H
PASADENA MD
21122-6925
US

IV. Provider business mailing address

2772 RUTLAND RD
DAVIDSONVILLE MD
21035-1228
US

V. Phone/Fax

Practice location:
  • Phone: 410-544-6483
  • Fax: 410-544-2027
Mailing address:
  • Phone: 443-607-1033
  • Fax: 443-607-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT GEORGE GRAW JR.
Title or Position: CEO
Credential: M.D.
Phone: 443-607-1033