Provider Demographics
NPI:1407454465
Name:ATLANTIC PORTABLE X-RAY, INC.
Entity Type:Organization
Organization Name:ATLANTIC PORTABLE X-RAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:410-433-4747
Mailing Address - Street 1:14103 FIESTA RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-5639
Mailing Address - Country:US
Mailing Address - Phone:410-433-4747
Mailing Address - Fax:410-237-6911
Practice Address - Street 1:9748 STEPHEN DECATUR HWY STE 113
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9358
Practice Address - Country:US
Practice Address - Phone:410-433-4747
Practice Address - Fax:410-237-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5000529509OtherSTATE OF MARYLAND - DEPARTMENT OF ASSESSMENTS AND TAXATION