Provider Demographics
NPI:1073511655
Name:MARYLAND DIAGNOSTIC SERVICES, INC.
Entity type:Organization
Organization Name:MARYLAND DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-354-1260
Mailing Address - Street 1:853 SECOND STREET PIKE
Mailing Address - Street 2:B104
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1082
Mailing Address - Country:US
Mailing Address - Phone:215-354-1260
Mailing Address - Fax:215-354-1266
Practice Address - Street 1:101 W RIDGELY RD
Practice Address - Street 2:7B
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5101
Practice Address - Country:US
Practice Address - Phone:410-628-6046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Not Answered246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty
Not Answered2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Not Answered246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD111523OtherAETNA
MDH444MAOtherCAREFIRST BC/BS
MDE509OtherCAREFIRST BLUECHOICE
MD111523OtherAETNA