Organization
MITCHELLVILLE RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER DUGAN (PRACTICE ADMINISTRATOR)
(301) 249-0022
Entity
Organization
Contact information
Practice address
1100 MERCANTILE LN, SUITE 150, LARGO, MD 20774-5380
(301) 249-0022
(301) 249-7640
Mailing address
PO BOX 79915, BALTIMORE, MD 21279-0915
(301) 498-2922
(301) 498-3074
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7926
BCBS-DC GROUP #
DC
01
—
H800DI
BCBS-MD GROUP #
MD
Enumeration date
04/12/2007
Last updated
10/15/2007
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