=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831283050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKLAND MRI CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 12/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 259 N. FOURTH ST.
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-533-4674
-----------------------------------------------------
Fax | 301-533-1077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 259 N. FOURTH ST.
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-533-4674
-----------------------------------------------------
Fax | 301-533-1077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RADIOLOGIST/BOARD MEMBER
-----------------------------------------------------
Name | DR. JOHN NICKOLAS PAPPAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 240-964-1045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0206X
-----------------------------------------------------
Taxonomy Name | Mammography Clinic/Center
-----------------------------------------------------
License Number | 11915560
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------