Organization
UNIVERSITY OF MARYLAND DIAGNOSTIC RADIOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES S WHITE MD (VICE PRESIDENT)
(410) 328-3477
Entity
Organization
Contact information
Practice address
5 N LA PLATA CT STE 104, LA PLATA, MD 20646-5207
(301) 539-0345
Mailing address
PO BOX 829688, PHILADELPHIA, PA 19182-9688
Taxonomy
Speciality
Code
Description
License number
State
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302245500
—
MD
Enumeration date
12/19/2016
Last updated
12/24/2019
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