Provider Demographics
NPI:1346202751
Name:MONTGOMERY-COMMUNITY MAGNETIC IMAGING CNTR LTD PARTNERSHIP
Entity type:Organization
Organization Name:MONTGOMERY-COMMUNITY MAGNETIC IMAGING CNTR LTD PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-438-5150
Mailing Address - Street 1:PO BOX 64940
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4940
Mailing Address - Country:US
Mailing Address - Phone:301-438-5150
Mailing Address - Fax:301-460-0199
Practice Address - Street 1:4110 ASPEN HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-2853
Practice Address - Country:US
Practice Address - Phone:301-438-5150
Practice Address - Fax:301-460-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024781400Medicaid
MD232261700Medicaid
MD232261700Medicaid