Provider Demographics
NPI:1902958796
Name:FT WASHINGTON RADIOLOGY
Entity Type:Organization
Organization Name:FT WASHINGTON RADIOLOGY
Other - Org Name:FT WASHINGTON HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-315-3030
Mailing Address - Street 1:11711 LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5151
Mailing Address - Country:US
Mailing Address - Phone:301-203-2599
Mailing Address - Fax:301-203-7892
Practice Address - Street 1:11711 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5151
Practice Address - Country:US
Practice Address - Phone:301-203-2599
Practice Address - Fax:301-203-7892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT WASHINGTON MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16-003282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG02177OtherMEDICARE GROUP
MDG02177Medicare PIN