Healthcare Provider Details

I. General information

NPI: 1174577969
Provider Name (Legal Business Name): MOBILE MEDICAL IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 PROSPERITY DR SUITE 455
SILVER SPRING MD
20904-1689
US

IV. Provider business mailing address

12501 PROSPERITY DR SUITE 455
SILVER SPRING MD
20904-1689
US

V. Phone/Fax

Practice location:
  • Phone: 301-680-1900
  • Fax: 301-680-0920
Mailing address:
  • Phone: 301-680-1900
  • Fax: 301-680-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DESMOND C BROWN
Title or Position: CEO
Credential: RT
Phone: 301-680-1900