Provider Demographics
NPI:1093809212
Name:ALLEGANY IMAGING, PC
Entity Type:Organization
Organization Name:ALLEGANY IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICKOLAS
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-964-1036
Mailing Address - Street 1:PO BOX 3206
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21504-3206
Mailing Address - Country:US
Mailing Address - Phone:240-964-1036
Mailing Address - Fax:240-964-1048
Practice Address - Street 1:12500 WILLOWBROOK RD
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6393
Practice Address - Country:US
Practice Address - Phone:240-964-1036
Practice Address - Fax:240-964-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404554800Medicaid
WV404554802Medicaid
WV0210145000Medicaid
MDDB0879Medicare PIN
WV9341071Medicare PIN
WV404554802Medicaid
MD831MMedicare ID - Type UnspecifiedTRAILBLAZERS