Provider Demographics
NPI:1831283050
Name:OAKLAND MRI CENTER, LLC
Entity Type:Organization
Organization Name:OAKLAND MRI CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST/BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICKOLAS
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-964-1045
Mailing Address - Street 1:259 N. FOURTH ST.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550
Mailing Address - Country:US
Mailing Address - Phone:301-533-4674
Mailing Address - Fax:301-533-1077
Practice Address - Street 1:259 N. FOURTH ST.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-533-4674
Practice Address - Fax:301-533-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2085R0202X
MD11915560261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, MammographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004265Medicaid
MDDE6532OtherRR PALMETTO
MDDE6532OtherRRMC
MD440643100Medicaid
MD210PMedicare UPIN
MD440643100Medicaid