Provider Demographics
NPI:1487654398
Name:DEDICATED IMAGING OF BALTIMORE
Entity Type:Organization
Organization Name:DEDICATED IMAGING OF BALTIMORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-605-9393
Mailing Address - Street 1:1030 N. CHARLES ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5402
Mailing Address - Country:US
Mailing Address - Phone:410-605-9393
Mailing Address - Fax:410-605-9397
Practice Address - Street 1:1030 N. CHARLES ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5402
Practice Address - Country:US
Practice Address - Phone:410-605-9393
Practice Address - Fax:410-605-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty