Basic Information
| Provider Information | |||||||||
| NPI: | 1710088075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METROPOLITAN RADIOLOGY ASSOCIATES CHARTERED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 BERWYN HOUSE RD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | COLLEGE PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012200150 | ||||||||
| FaxNumber: | 3012201032 | ||||||||
| Practice Location | |||||||||
| Address1: | 3327 SUPERIOR LANE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012622202 | ||||||||
| FaxNumber: | 3012620382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 11/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | MULLEN | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 3016140595 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 356801600 | 05 | MD | MEDICAID |