Provider Demographics
NPI:1881617256
Name:GREENBELT PET IMAGING CENTER, LLC
Entity type:Organization
Organization Name:GREENBELT PET IMAGING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-441-9696
Mailing Address - Street 1:PO BOX 34979
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20827-0979
Mailing Address - Country:US
Mailing Address - Phone:301-446-1728
Mailing Address - Fax:301-446-0022
Practice Address - Street 1:7474 GREENWAY CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3504
Practice Address - Country:US
Practice Address - Phone:301-446-1728
Practice Address - Fax:301-446-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFMN007Medicare ID - Type UnspecifiedRADIOLOGY IDTF