Provider Demographics
NPI:1609884238
Name:F. DANIEL JACKSON, MD, PA T/A THE IMAGING CENTER
Entity Type:Organization
Organization Name:F. DANIEL JACKSON, MD, PA T/A THE IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-759-3817
Mailing Address - Street 1:PO BOX 1692
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1692
Mailing Address - Country:US
Mailing Address - Phone:301-759-3817
Mailing Address - Fax:301-759-3286
Practice Address - Street 1:715 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6390
Practice Address - Country:US
Practice Address - Phone:301-759-3410
Practice Address - Fax:301-759-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01-01-22261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD433LMedicare ID - Type Unspecified