Provider Demographics
NPI:1942313127
Name:PARKWAY VENTURES, INC. AND SUBSIDIARIES
Entity Type:Organization
Organization Name:PARKWAY VENTURES, INC. AND SUBSIDIARIES
Other - Org Name:MEDSTAR PET SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIONNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-902-1071
Mailing Address - Street 1:5233 KING AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4003
Mailing Address - Country:US
Mailing Address - Phone:410-491-0992
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2945
Practice Address - Country:US
Practice Address - Phone:410-933-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD470001619OtherRAILROAD MEDICARE