MEDICARE: OLNEY OPEN MRI 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	2471C3402X	Radiography Radiologic Technologist		MD
2	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912044314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLNEY OPEN MRI LLC

Provider Business Mailing Address
First Line	:	PO BOX 64354
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264
Country	:	US
Telephone Number	:	703-667-8612
Fax Number	:	703-970-2894

Provider Business Practice Location Address
First Line	:	3300 OLNEY SANDY SPRING RD
Second Line	:	SUITE 100
City	:	OLNEY
State	:	MD
Zip	:	20832-1494
Country	:	US
Telephone Number	:	301-260-2971
Fax Number	:	301-260-7971

Authorized Official
Title or Position	:	CEO
Name	:	ADAM STARR
Credential	:
Telephone Number	:	703-667-8612

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	09/20/2017

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1902369168 — NANA A MENSAH FNP, AANP
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Directions to “OLNEY OPEN MRI LLC ” Practice Location

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