Provider Demographics
NPI:1063699940
Name:FREDERICK IMAGING CENTERS, LLC
Entity type:Organization
Organization Name:FREDERICK IMAGING CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KORANGY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:410-764-0912
Mailing Address - Street 1:PO BOX 5847
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21282-5847
Mailing Address - Country:US
Mailing Address - Phone:410-764-0912
Mailing Address - Fax:410-764-0647
Practice Address - Street 1:46B THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-696-1410
Practice Address - Fax:301-696-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty