Provider Demographics
NPI:1912044314
Name:OLNEY OPEN MRI LLC
Entity Type:Organization
Organization Name:OLNEY OPEN MRI LLC
Other - Org Name:PROGRESSIVE RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-667-8612
Mailing Address - Street 1:PO BOX 64354
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264
Mailing Address - Country:US
Mailing Address - Phone:703-667-8612
Mailing Address - Fax:703-970-2894
Practice Address - Street 1:3300 OLNEY SANDY SPRING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1494
Practice Address - Country:US
Practice Address - Phone:301-260-2971
Practice Address - Fax:301-260-7971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
MD2471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403940801Medicaid
MD784MMedicare PIN
MDCK4954Medicare PIN
DCG01031Medicare PIN