Provider Demographics
NPI:1598756645
Name:THE MRI CENTER AT WHITE MARSH, LLC
Entity Type:Organization
Organization Name:THE MRI CENTER AT WHITE MARSH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MULREANEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:410-931-6674
Mailing Address - Street 1:9900 FRANKLIN SQUARE DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236
Mailing Address - Country:US
Mailing Address - Phone:410-931-6674
Mailing Address - Fax:410-931-2989
Practice Address - Street 1:9900 FRANKLIN SQUARE DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236
Practice Address - Country:US
Practice Address - Phone:410-931-6674
Practice Address - Fax:410-931-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
MDM2492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00135265OtherRAILROAD MEDICARE
MD403128800Medicaid
MD403128800Medicaid
FMX-013Medicare UPIN