Provider Demographics
NPI:1447456868
Name:NORTHERN BALTIMORE IMAGING, LLC
Entity type:Organization
Organization Name:NORTHERN BALTIMORE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BRANDT
Authorized Official - Last Name:STEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-321-0096
Mailing Address - Street 1:1107 KENILWORTH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2140
Mailing Address - Country:US
Mailing Address - Phone:410-321-0096
Mailing Address - Fax:410-321-0098
Practice Address - Street 1:1107 KENILWORTH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2140
Practice Address - Country:US
Practice Address - Phone:410-321-0096
Practice Address - Fax:410-321-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology