Provider Demographics
NPI:1417131467
Name:LIVE RADIOLOGY, LLC
Entity Type:Organization
Organization Name:LIVE RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BONDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-694-2630
Mailing Address - Street 1:176 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4410
Mailing Address - Country:US
Mailing Address - Phone:301-694-2630
Mailing Address - Fax:301-694-2307
Practice Address - Street 1:176 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4410
Practice Address - Country:US
Practice Address - Phone:301-694-2630
Practice Address - Fax:301-694-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM369261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology