NPI 1063702603 · live from the CMS NPI Registry
Matthew Moon
Radiology, Diagnostic Radiology in Baltimore, MD. National Provider Identifier 1063702603, active.
NPI record
| NPI | 1063702603 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 601 N Caroline St, Baltimore, MD 21287 |
| Practice phone | 410-955-9446 |
| Mailing address | 4755 Ogletown Stanton Rd, Newark, DE 19718 |
| Enumerated | April 16, 2011 |
| Last updated | August 9, 2017 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology | 2085R0202X | C1-0010155 (DE) |
| Radiology, Diagnostic Radiology primary | 2085R0202X | D81267 (MD) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.