Provider Demographics
NPI:1225525256
Name:ADVANCED IMAGING DIAGNOSTICS,LLC
Entity Type:Organization
Organization Name:ADVANCED IMAGING DIAGNOSTICS,LLC
Other - Org Name:ADVANCED IMAGING DIAGNOSTICS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ADAORA
Authorized Official - Middle Name:PERPETUA
Authorized Official - Last Name:NOUMMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-899-5315
Mailing Address - Street 1:10815 LEGEND MANOR LN
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2306
Mailing Address - Country:US
Mailing Address - Phone:240-899-5315
Mailing Address - Fax:877-253-6952
Practice Address - Street 1:12501 PROSPERITY DR STE 330
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1655
Practice Address - Country:US
Practice Address - Phone:301-604-4033
Practice Address - Fax:877-253-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026012207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD331441300Medicaid
MD502474OtherINDIVIDUAL