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General NPI Number Information
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NPI Number | 1952138117
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Entity Type | Organization
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Legal Business Name | MARYLAND IMAGING NETWORK PC
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 10400 ODONNELL PL STE 100
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City | WALDORF
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State | MD
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Zip | 20603-7290
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Country | US
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Telephone | 410-298-0454
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Fax | 301-694-2606
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Provider Business Mailing Address
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Address Line | 10461 MILL RUN CIR STE 1020
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5544
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Country | US
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Telephone | 443-436-1221
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Fax | 443-436-1256
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN VERNON CRUES
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Credential | M.D.
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Telephone | 310-445-2843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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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 | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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