=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164692240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCEAN MEDICAL IMAGING OF DELAWARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2008
-----------------------------------------------------
Last Update Date | 08/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 FEDERAL ST STE 4
-----------------------------------------------------
City | MILTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19968-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-684-5151
-----------------------------------------------------
Fax | 302-684-1977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 FEDERAL ST STE 4
-----------------------------------------------------
City | MILTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19968-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-684-5151
-----------------------------------------------------
Fax | 302-684-1977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JONATHAN L PATTERSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 302-684-5151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | C1-0004811
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0206X
-----------------------------------------------------
Taxonomy Name | Mammography Clinic/Center
-----------------------------------------------------
License Number | C1-0004811
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------