Organization
MIDATLANTIC DIAGNOSTIC IMAGING CENTERS LLC
Active
Other names
ELICOTT OPEN MRI
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN TUCKER (PRESIDENT)
(410) 480-0082
Entity
Organization
Contact information
Practice address
3570 SAINT JOHNS LN, SUITE 104 B, ELLICOTT CITY, MD 21042-4020
(410) 480-0082
Mailing address
3570 SAINT JOHNS LN, SUITE 104 B, ELLICOTT CITY, MD 21042-4020
(410) 480-0082
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
—
—
2085N0700X
Neuroradiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970BEL
BLUE SHIELD
MD
01
—
K676
GHI
DC
Enumeration date
12/29/2006
Last updated
01/09/2008
Update your record
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