Provider Demographics
NPI:1487296471
Name:MARYLAND IMAGING NETWORK PC
Entity type:Organization
Organization Name:MARYLAND IMAGING NETWORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:CRUES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-445-4800
Mailing Address - Street 1:10461 MILL RUN CIR STE 1200
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4204
Mailing Address - Country:US
Mailing Address - Phone:443-436-1116
Mailing Address - Fax:443-436-1256
Practice Address - Street 1:130 HOSPITAL RD STE LL100
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4029
Practice Address - Country:US
Practice Address - Phone:410-298-0454
Practice Address - Fax:301-694-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty