Mobile Medical Imaging, LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

MOBILE MEDICAL IMAGING, LLC

Practice address

12501 Prosperity Dr
Suite 455
Silver Spring, MD 20904-1689

Phone

(301) 680-1900

Fax

(301) 680-0920

NPI assigned

Apr 18, 2007

Reactivated

Feb 25, 2011

Last updated

Apr 20, 2017By 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

Mr. Desmond Courtney Brown, RT

Title

Ceo

Phone

(301) 680-1900

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1306062195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12501 PROSPERITY DR",
            "address_2": "SUITE 455",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209041689",
            "telephone_number": "301-680-1900",
            "fax_number": "301-680-0920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12501 PROSPERITY DR",
            "address_2": "SUITE 455",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209041689",
            "telephone_number": "301-680-1900",
            "fax_number": "301-680-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICAL IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2017-04-20",
        "deactivation_date": "2008-08-12",
        "reactivation_date": "2011-02-25",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DESMOND",
        "authorized_official_middle_name": "COURTNEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-680-1900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RT"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "P01391384",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04697300",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "777788400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mobile Medical Care, Inc.
• Gina Mobley, LCPC
• Motunrayo Mobolaji-Lawal, MD
• Gina Modera, MOT, OTR/L
• Sheela D Modin, M.D.
• Peter Modlin, LCPC

• Physiological Laboratory in Silver Spring, MD
• Providers in Silver Spring, MD by specialty
• Physiological Laboratory in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.