Healthcare Provider Details

I. General information

NPI: 1093756843
Provider Name (Legal Business Name): MOBILE RADIOLOGY LABS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RESEARCH CT
ROCKVILLE MD
20850-6222
US

IV. Provider business mailing address

PO BOX 520
MARSHALL VA
20116-0520
US

V. Phone/Fax

Practice location:
  • Phone: 301-782-2377
  • Fax: 301-782-7724
Mailing address:
  • Phone: 301-782-2377
  • Fax: 301-782-7724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: JAMES L TARVER
Title or Position: PRESIDENT
Credential: N/A
Phone: 301-782-2377