Provider Demographics
NPI:1861501959
Name:TLC IMAGING LLC
Entity Type:Organization
Organization Name:TLC IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEELAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-809-6442
Mailing Address - Street 1:1107 KENILWORTH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1107 KENILWORTH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2140
Practice Address - Country:US
Practice Address - Phone:410-321-0096
Practice Address - Fax:410-321-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFMX022Medicare ID - Type UnspecifiedIDTF