Provider Demographics
NPI:1164192365
Name:MID-ATLANTIC MOBILE MEDICAL IMAGING, LLC.
Entity Type:Organization
Organization Name:MID-ATLANTIC MOBILE MEDICAL IMAGING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FIKREMARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEBSIBE
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT
Authorized Official - Phone:301-395-3055
Mailing Address - Street 1:4303 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7331
Mailing Address - Country:US
Mailing Address - Phone:301-395-3055
Mailing Address - Fax:
Practice Address - Street 1:5276 DAWES AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1404
Practice Address - Country:US
Practice Address - Phone:571-777-8494
Practice Address - Fax:571-777-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty