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General NPI Number Information
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NPI Number | 1447283536
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Entity Type | Organization
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Legal Business Name | VYMED DIAGNOSTIC IMAMAGING/SALISBURY LLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 B EAST VINE STREET
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City | SALISBURY
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State | MD
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Zip | 21804
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Country | US
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Telephone | 813-496-1075
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Fax | 813-249-7762
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Provider Business Mailing Address
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Address Line | 4519 GEORGE RD STE 100
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City | TAMPA
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State | FL
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Zip | 33634-7329
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Country | US
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Telephone | 813-496-1075
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Fax | 813-249-7762
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LYLE SENSENBRENNER
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Credential | MD
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Telephone | 813-496-1075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | D10503
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License Number State | MD
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