Provider Demographics
NPI:1609894674
Name:CT IMAGING OF GREENWAY, LLC
Entity Type:Organization
Organization Name:CT IMAGING OF GREENWAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADZIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-420-9980
Mailing Address - Street 1:602 S ATWOOD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4172
Mailing Address - Country:US
Mailing Address - Phone:410-420-9980
Mailing Address - Fax:410-420-9975
Practice Address - Street 1:7525 GREENWAY CENTER DR
Practice Address - Street 2:T1
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3509
Practice Address - Country:US
Practice Address - Phone:301-982-1919
Practice Address - Fax:301-982-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM317174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFDX 023Medicare ID - Type UnspecifiedRADIOLOGY