Provider Demographics
NPI:1346604295
Name:PHYSICIAN IMAGING OF WASHINGTON HOSPITAL CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIAN IMAGING OF WASHINGTON HOSPITAL CENTER, LLC
Other - Org Name:MEDSTAR RADIOLOGY NETWORK AT BRANDYWINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:MEGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-540-4429
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7270
Mailing Address - Country:US
Mailing Address - Phone:615-261-2306
Mailing Address - Fax:855-588-3545
Practice Address - Street 1:13950 BRADYWINE ROAD
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613
Practice Address - Country:US
Practice Address - Phone:301-209-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty