MEDICARE: NIGHTTIME RADIOLOGY NORTH 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
1	247100000X	Radiologic Technologist

General Provider Information

NPI Number	:	1699839860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIGHTTIME RADIOLOGY NORTH LLC

Provider Business Mailing Address
First Line	:	2772 RUTLAND RD
Second Line	:
City	:	DAVIDSONVILLE
State	:	MD
Zip	:	21035-1228
Country	:	US
Telephone Number	:	443-607-1033
Fax Number	:	443-607-1041

Provider Business Practice Location Address
First Line	:	8125 RITCHIE HWY STE H
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-6925
Country	:	US
Telephone Number	:	410-544-6483
Fax Number	:	410-544-2027

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROBERT GEORGE GRAW JR.
Credential	:	M.D.
Telephone Number	:	443-607-1033

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/22/2020

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