Provider Demographics
NPI:1851664122
Name:CHESAPEAKE OPEN MRI LLC
Entity Type:Organization
Organization Name:CHESAPEAKE OPEN MRI LLC
Other - Org Name:CHESAPEAKE MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-571-0350
Mailing Address - Street 1:4600 WILKENS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4843
Mailing Address - Country:US
Mailing Address - Phone:410-242-8335
Mailing Address - Fax:410-242-8339
Practice Address - Street 1:4600 WILKENS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4843
Practice Address - Country:US
Practice Address - Phone:410-242-8335
Practice Address - Fax:410-242-8339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD444962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty