Provider Demographics
NPI:1114466745
Name:CHESAPEAKE OPEN MRI L L C
Entity type:Organization
Organization Name:CHESAPEAKE OPEN MRI L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAGANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-571-0350
Mailing Address - Street 1:122 DEFENSE HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7044
Mailing Address - Country:US
Mailing Address - Phone:410-931-0400
Mailing Address - Fax:410-931-1009
Practice Address - Street 1:8114 SANDPIPER CIR
Practice Address - Street 2:SUITE 106
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4934
Practice Address - Country:US
Practice Address - Phone:443-693-5110
Practice Address - Fax:443-693-7925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty