Basic Information
| Provider Information | |||||||||
| NPI: | 1376081406 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN VIRGINIA IMAGING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7801 OLD BRANCH AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207351608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018566718 | ||||||||
| FaxNumber: | 3018566722 | ||||||||
| Practice Location | |||||||||
| Address1: | 4 PIDGEON HILL DR | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201656173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034505800 | ||||||||
| FaxNumber: | 7034500495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2017 | ||||||||
| LastUpdateDate: | 06/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | FINIZIO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3018566718 | ||||||||
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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 | 173000000X | B194224 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Legal Medicine |
No ID Information.