Basic Information
| Provider Information | |||||||||
| NPI: | 1538341540 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MRI OF WOODBRIDGE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778459689 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2200 OPITZ BLVD | ||||||||
| Address2: | SUITES 335&320 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221913321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034903677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 11/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7034903677 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.