Basic Information
| Provider Information | |||||||||
| NPI: | 1356507412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AAR WOODBRIDGE IMAGING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778459689 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4001 PRINCE WILLIAM PKWY | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221927630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034943309 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2008 | ||||||||
| LastUpdateDate: | 07/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | BARBU | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7038243210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | CJ8320 | 01 | RR MEDICARE | OTHER |