Balum Imaging LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

M478 Issued in MD

Legal business name

BALUM IMAGING LLC

Practice address

5500 Knoll North Dr
Suite 190
Columbia, MD 21045-2370

Phone

(443) 917-2700

Fax

(410) 415-1418

NPI assigned

Nov 19, 2015

Last updated

Nov 19, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew Scott Dehaven

Title

Ceo

Phone

(443) 917-2700

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447891200000",
    "number": "1063886612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 KNOLL NORTH DR",
            "address_2": "SUITE 190",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452370",
            "telephone_number": "443-917-2700",
            "fax_number": "410-415-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 KNOLL NORTH DR",
            "address_2": "SUITE 190",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452370",
            "telephone_number": "443-917-2700",
            "fax_number": "410-415-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALUM IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-19",
        "last_updated": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "DEHAVEN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-917-2700"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "MD",
            "license": "M478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tosin Balogun
• Jessica Balonis, CRNP
• Katrina Louise Balovlenkov, LCSW-C
• Carol Rendon Baltazar, M.D.
• Baltimore Washington Surgery Center, L.L.C.
• Aisha Bamidele
• Philomera Bamugye Jones
• Clement S. K. Banda, M.D.
• Tafadzwa Banda
• Nitika Bansal Bandara, MD

• Radiology Clinic/Center in Columbia, MD
• Providers in Columbia, MD by specialty
• Radiology Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.