Provider Demographics
NPI:1861476343
Name:SHIPLEY'S IMAGING, LLC
Entity Type:Organization
Organization Name:SHIPLEY'S IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVDE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-481-5335
Mailing Address - Street 1:SHIPLEY'S IMAGING, LLC
Mailing Address - Street 2:PO BOX 404442
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4442
Mailing Address - Country:US
Mailing Address - Phone:804-756-5130
Mailing Address - Fax:804-672-6899
Practice Address - Street 1:8601 VETERANS HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1547
Practice Address - Country:US
Practice Address - Phone:410-729-4451
Practice Address - Fax:410-729-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDACR 131072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3811OtherCAREFIRST BCBS
MD110800000Medicaid
CN6292OtherRAILROAD MEDICARE
MD147397700OtherFEDERAL WORKMAN'S COMP
MDKC46SHOtherCAREFIRST
MDKC46SHOtherCAREFIRST