Healthcare Provider Details

I. General information

NPI: 1073511655
Provider Name (Legal Business Name): MARYLAND DIAGNOSTIC SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W RIDGELY RD 7B
TIMONIUM MD
21093-5101
US

IV. Provider business mailing address

853 SECOND STREET PIKE B104
RICHBORO PA
18954-1082
US

V. Phone/Fax

Practice location:
  • Phone: 410-628-6046
  • Fax:
Mailing address:
  • Phone: 215-354-1260
  • Fax: 215-354-1266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL COREN
Title or Position: PRESIDENT
Credential:
Phone: 215-354-1260