Basic Information
| Provider Information | |||||||||
| NPI: | 1255422325 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN VIRGINIA IMAGING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7801 OLD BRANCH AVE | ||||||||
| Address2: | #300 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207351608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018566718 | ||||||||
| FaxNumber: | 3018566722 | ||||||||
| Practice Location | |||||||||
| Address1: | 19455 DEERFIELD AVEUNE | ||||||||
| Address2: | 102 &103 | ||||||||
| City: | LANSDOWNE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038580001 | ||||||||
| FaxNumber: | 3018566722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2006 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | FINIZIO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR RADIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 3018566718 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 238799 | 01 | VA | ANTHEM | OTHER | 624477 | 01 | VA | ALLIANCE (NON-MRI) | OTHER | 1428934 | 01 | VA | AETNA HMO | OTHER | 924468 | 01 | VA | ALLIANCE (MRI) | OTHER | KX07RA | 01 | VA | CAREFIRST GROUP NUMBER | OTHER | 1602470 | 01 | VA | UNITED HEALTH CARE | OTHER | 0679 | 01 | VA | CAREFIRST NCA GROUP NUMBE | OTHER | 7200501 | 01 | VA | MEDICAID | OTHER | 7406939 | 01 | VA | AETNA PPO | OTHER |