Organization
BALUM IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW SCOTT DEHAVEN (CEO)
(443) 917-2700
Entity
Organization
Contact information
Practice address
5500 KNOLL NORTH DR, SUITE 190, COLUMBIA, MD 21045-2370
(443) 917-2700
(410) 415-1418
Mailing address
5500 KNOLL NORTH DR, SUITE 190, COLUMBIA, MD 21045-2370
(443) 917-2700
(410) 415-1418
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
M478
MD
Other
Enumeration date
11/19/2015
Last updated
11/19/2015
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