Provider Demographics
NPI:1518406156
Name:CHESAPEAKE OPEN MRI LLC
Entity Type:Organization
Organization Name:CHESAPEAKE OPEN MRI LLC
Other - Org Name:CHESAPEAKE MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAGANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-571-0350
Mailing Address - Street 1:PO BOX 824106
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4106
Mailing Address - Country:US
Mailing Address - Phone:410-931-0400
Mailing Address - Fax:410-931-1009
Practice Address - Street 1:1312 BELLONA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5400
Practice Address - Country:US
Practice Address - Phone:410-921-3378
Practice Address - Fax:410-921-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty