1366634107 NPI number — WASHINGTON IMAGING ASSOCIATES - MARYLAND LLC

Table of content: (NPI 1366634107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366634107 NPI number — WASHINGTON IMAGING ASSOCIATES - MARYLAND LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON IMAGING ASSOCIATES - MARYLAND 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:
1366634107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7799 LEESBURG PIKE
Provider Second Line Business Mailing Address:
SUITE 1008-N
Provider Business Mailing Address City Name:
MCLEAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-442-4714
Provider Business Mailing Address Fax Number:
703-442-4715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 JERMANTOWN RD STE 550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22030-2885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-667-8600
Provider Business Practice Location Address Fax Number:
703-667-8601
Provider Enumeration Date:
08/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TU
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
202-997-7000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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