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General NPI Number Information
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NPI Number | 1528022480
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Entity Type | Organization
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Legal Business Name | MAIDEN CHOICE NUCLEAR IMAGING CENTER
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 724 MAIDEN CHOICE LN SUITE 202
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City | BALTIMORE
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State | MD
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Zip | 21228-5911
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Country | US
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Telephone | 410-747-3300
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Fax | 410-455-0009
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Provider Business Mailing Address
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Address Line | 724 MAIDEN CHOICE LN SUITE 202
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City | BALTIMORE
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State | MD
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Zip | 21228-5911
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Country | US
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Telephone | 410-747-3300
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Fax | 410-455-0009
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Authorized Official
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Title or Position | PRESIDENT OF BOARD
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Name | HOMAYOON MOGHBELI
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Credential | MD
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Telephone | 410-747-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | MD0512101
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License Number State | MD
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