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General NPI Number Information
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NPI Number | 1184894024
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Entity Type | Organization
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Legal Business Name | SONOSCAN LLC
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 10/18/2023
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Provider Practice Location Address
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Address Line | 12F QUEEN ANNE WAY
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City | CHESTER
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State | MD
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Zip | 21619-2538
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Country | US
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Telephone | 443-870-3750
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Fax |
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Provider Business Mailing Address
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Address Line | 12F QUEEN ANNE WAY
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City | CHESTER
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State | MD
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Zip | 21619-2538
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Country | US
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Telephone | 443-870-3750
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Fax |
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Authorized Official
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Title or Position | PREISDENT AND CEO
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Name | NICK TKESHELASHVILI
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Credential | MD
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Telephone | 443-710-7017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C1101X
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Taxonomy Name | Cardiovascular-Interventional Technology Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2471N0900X
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Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2471V0106X
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Taxonomy Name | Vascular-Interventional Technology Radiologic Technologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number |
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License Number State |
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