Provider Demographics
NPI:1437118726
Name:OPEN MRI
Entity Type:Organization
Organization Name:OPEN MRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-472-5555
Mailing Address - Street 1:1602 NEWPORT GAP PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6208
Mailing Address - Country:US
Mailing Address - Phone:302-633-5840
Mailing Address - Fax:302-588-5844
Practice Address - Street 1:1010 N BANCROFT PKWY
Practice Address - Street 2:SUITE 101 TROLLEY SQUARE
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2690
Practice Address - Country:US
Practice Address - Phone:302-472-5555
Practice Address - Fax:302-472-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0351692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000034834Medicaid
CT=========OtherBCBS OF DE
DE1000034834Medicaid
DEFDX020Medicare ID - Type Unspecified