Provider Demographics
NPI:1528012119
Name:GERMANTOWN OUTPATIENT IMAGING, LLC
Entity Type:Organization
Organization Name:GERMANTOWN OUTPATIENT IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSCHING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-948-5700
Mailing Address - Street 1:19650 CLUB HOUSE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTGOMRY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3039
Mailing Address - Country:US
Mailing Address - Phone:301-948-5700
Mailing Address - Fax:240-683-3612
Practice Address - Street 1:19731 GERMANTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1203
Practice Address - Country:US
Practice Address - Phone:301-948-5700
Practice Address - Fax:240-683-3612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409637Medicare ID - Type UnspecifiedSGRC MEDICARE