Provider Demographics
NPI:1699516161
Name:MARYLAND IMAGING NETWORK PC
Entity type:Organization
Organization Name:MARYLAND IMAGING NETWORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:CRUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-445-2843
Mailing Address - Street 1:10461 MILL RUN CIR STE 1020
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5544
Mailing Address - Country:US
Mailing Address - Phone:443-436-1221
Mailing Address - Fax:443-436-1256
Practice Address - Street 1:3510 OLD WASHINGTON RD STE 101
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3234
Practice Address - Country:US
Practice Address - Phone:410-298-0454
Practice Address - Fax:443-436-1214
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYLAND IMAGING NETWORK PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty