Provider Demographics
NPI:1710920061
Name:PROGRESSIVE NEUROSKELETAL IMAGING
Entity Type:Organization
Organization Name:PROGRESSIVE NEUROSKELETAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:301-528-4332
Mailing Address - Street 1:9601 BLACKWELL RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3472
Mailing Address - Country:US
Mailing Address - Phone:301-251-7897
Mailing Address - Fax:301-251-7898
Practice Address - Street 1:19847 CENTURY BLVD
Practice Address - Street 2:SUITE 275
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-7201
Practice Address - Country:US
Practice Address - Phone:301-528-4332
Practice Address - Fax:301-528-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408087400Medicaid
MD408087400Medicaid