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NPI Code Detail

MEDICARE: WESTERN MD PET IMAGING LLC

MEDICARE: WESTERN MD PET IMAGING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DB6053OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3J248OTHERMDMD BLUE SHIELD
4217AOTHERMDMD BLUE SHIELD

General Provider Information

NPI Number : 1306849351
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTERN MD PET IMAGING LLC
Provider Business Mailing Address
First Line : PO BOX 808
Second Line :
City : CUMBERLAND
State : MD
Zip : 21501-0808
Country : US
Telephone Number : 301-724-1646
Fax Number : 301-724-7429
Provider Business Practice Location Address
First Line : 952 SETON DR
Second Line :
City : CUMBERLAND
State : MD
Zip : 21502-1950
Country : US
Telephone Number : 301-777-3522
Fax Number : 301-777-1902
Authorized Official
Title or Position : PRESIDENT
Name : DR. JONG K KIM
Credential : M.D.
Telephone Number : 301-724-1646
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/25/2007

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Directions to “WESTERN MD PET IMAGING LLC ” Practice Location

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