=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780172049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MD DIAGNOSTICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2018
-----------------------------------------------------
Last Update Date | 10/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 YORK RD STE 190D
-----------------------------------------------------
City | LUTHERVILLE TIMONIUM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-6016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-946-9552
-----------------------------------------------------
Fax | 443-288-5205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1300 YORK RD STE 190D
-----------------------------------------------------
City | LUTHERVILLE TIMONIUM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-6016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-946-9552
-----------------------------------------------------
Fax | 443-288-5205
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MINNIE CENIZA TAMPUS
-----------------------------------------------------
Credential | CRNP
-----------------------------------------------------
Telephone | 443-288-5206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------