Individual
REGINALD SCOTT WIDEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4940 EASTERN AVENUE, BALTIMORE, MD 21264-2925
(410) 550-0100
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-6423
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D0101352
MD
Other
Enumeration date
04/10/2018
Last updated
08/01/2024
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