Provider Demographics
NPI:1811162050
Name:MARYLAND MRI L.L.C.
Entity type:Organization
Organization Name:MARYLAND MRI L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:GAETJENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-483-4440
Mailing Address - Street 1:7409 VAN DUSEN RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6400
Mailing Address - Country:US
Mailing Address - Phone:301-483-4440
Mailing Address - Fax:301-483-7982
Practice Address - Street 1:7409 VAN DUSEN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-6400
Practice Address - Country:US
Practice Address - Phone:301-483-4440
Practice Address - Fax:301-483-7982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD144120Medicare UPIN