Basic Information
| Provider Information | |||||||||
| NPI: | 1184647067 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPUTED TOMOGRAPHY ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 N BEAUREGARD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038243200 | ||||||||
| FaxNumber: | 7038243522 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 N BEAUREGARD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038243200 | ||||||||
| FaxNumber: | 7038243522 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7038243200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CA8381 | 01 | RAILROAD MEDICARE | OTHER |