Basic Information
Provider Information | |||||||||
NPI: | 1992097521 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ATLANTIC GENERAL HOSPITAL CORP. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | TMC IMAGING | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10026 OLD OCEAN CITY BLVD | ||||||||
Address2: | BUILDING #1 | ||||||||
City: | BERLIN | ||||||||
State: | MD | ||||||||
PostalCode: | 218111288 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4106296012 | ||||||||
FaxNumber: | 4106419515 | ||||||||
Practice Location | |||||||||
Address1: | 1001 PHILADELPHIA AVE | ||||||||
Address2: |   | ||||||||
City: | OCEAN CITY | ||||||||
State: | MD | ||||||||
PostalCode: | 218423735 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4102896241 | ||||||||
FaxNumber: | 4102895533 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/16/2011 | ||||||||
LastUpdateDate: | 11/17/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NOTTINGHAM | ||||||||
AuthorizedOfficialFirstName: | CHERYL | ||||||||
AuthorizedOfficialMiddleName: | LEWIS | ||||||||
AuthorizedOfficialTitleorPosition: | VP FINANCE/CFO | ||||||||
AuthorizedOfficialTelephone: | 4106419600 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/17/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 45-0219 | MD | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.