1255422325 NPI number — NORTHERN VIRGINIA IMAGING, LLC

Table of content: (NPI 1255422325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255422325 NPI number — NORTHERN VIRGINIA IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN VIRGINIA IMAGING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255422325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7801 OLD BRANCH AVE
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20735-1608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-856-6718
Provider Business Mailing Address Fax Number:
301-856-6722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19455 DEERFIELD AVEUNE
Provider Second Line Business Practice Location Address:
102 &103
Provider Business Practice Location Address City Name:
LANSDOWNE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-858-0001
Provider Business Practice Location Address Fax Number:
301-856-6722
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FINIZIO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DIRECTOR RADIOLOGIST
Authorized Official Telephone Number:
301-856-6718

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 238799 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 624477 . This is a "ALLIANCE (NON-MRI)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1428934 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 924468 . This is a "ALLIANCE (MRI)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: KX07RA . This is a "CAREFIRST GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1602470 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0679 . This is a "CAREFIRST NCA GROUP NUMBE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7200501 . This is a "MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7406939 . This is a "AETNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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