Provider Demographics
NPI:1922098052
Name:IMAGING CENTER MARYLAND, LLC
Entity Type:Organization
Organization Name:IMAGING CENTER MARYLAND, LLC
Other - Org Name:PROSCAN IMAGING COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-924-5174
Mailing Address - Street 1:8827 CENTRE PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2156
Mailing Address - Country:US
Mailing Address - Phone:410-772-3232
Mailing Address - Fax:410-772-3299
Practice Address - Street 1:8827 CENTRE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2156
Practice Address - Country:US
Practice Address - Phone:410-772-3232
Practice Address - Fax:410-772-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM2272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK8021OtherRAILROAD MEDICARE
MD358341400Medicaid
MD421PMedicare PIN