MEDICARE: THE MRI CENTER AT WHITE MARSH, 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1992003867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MRI CENTER AT WHITE MARSH, LLC

Provider Business Mailing Address
First Line	:	9900 FRANKLIN SQUARE DR
Second Line	:	SUITE D
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-5915
Country	:	US
Telephone Number	:	410-931-6674
Fax Number	:	410-931-2989

Provider Business Practice Location Address
First Line	:	1734 YORK RD
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-5606
Country	:	US
Telephone Number	:	410-530-7260
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT PATRICK MULREANEY
Credential	:	C.P.A.
Telephone Number	:	410-931-6674

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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